Dimensions change and left ventricular function carvedilol post therapy due to heart failure cases in children with congenital heart disease left-to-right

Background: Congenital Heart Disease (CHD) is the most common congenital disorder in newborns with a prevalence of 9.1 per 1000 live births. In left-to-right PJB shunts occur excessive volume burden on the ventricles, resulting in heart failure. Purpose: Knowing the difference in changes in the dimensions and function of the left ventricle on echocardiography after standard therapy plus placebo with the standard therapy group plus carvedilol in children with heart failure due to left-to-right CHD. Method: Using a Randomized Controlled Trial (RCT) research design by giving a Double Blind Study treatment. Research data including comparison of initial data and final data of the two groups were analyzed by independent sample t test. Result: The results of measurement of left ventricular mass showed a significant decrease to 40.56 ± 23.63 g / m2 (p <0.001). There was a significant decrease in left ventricular volume to 42.23 ± 20.36 m3 (p = 0.05). There was a significant increase in the mean left ventricular ejection fraction to 74.16 ± 4.10% (p = 0.03). There was an increase in the left ventricular shortening fraction to 42.18 ± 3.66% (p = 0.04). Conclusion: There are differences in the dimensions of the left ventricular at the end of systolic (DVKI-AS), the left ventricle at the end of diastolic (VKI-AD), the thickness of the back wall of the left ventricle at the end of diastolic (DBVKI-AD), and the thickness of the interventricular septum at the end of diastolic (SIV-AD)

Efficacy and Safety of Transcatheter Ventricular Septal Defect Closure Using Nit-Occlud Le VSD coil in Short-term Observation

Nit-Occlud Le VSD coil, an alternative device for closing VSD transcatheter, started to be used in dr. Soetomo Hosptal in 2017, but no research has been done on the results of closure with this device. This study aims to evaluate the efficacy and safety of the Nit-Occlud Le VSD coil. Descriptive observational method was used. The results are as follow:&nbsp; Of the 17 patients who underwent transcatheter closure during January to December 2018, 10 (58, 8%) cases were closed with Nit- Occlud Le VSD coil. The success of implantation is 100%, 8 cases were closed with Nit-Occlud Le VSD coil, 2 plus an amplatzer (ADO 1 and AVSO). Type of VSD: perimembranaous 7 (70%), subaortic 2 (20%) and mid muscularis 1 (10%). Immediate complete closure in 7/10 (70%), while 3 (30%) obtained residual DSV. The closure rate at the first month of follow up becomes 80%. Median length of post-catheterization was 2 days (2 - 3 days). Complications: 1 (10%) mild aortic regurgitation, 1 (10%) hemolysis and 2 (20%) with additional second device (ADO 1 and AVSO): first case: moderate residual VSD and severe aortic regurgitation; second case: severe tricuspid regurgitation and residual VSD that disappeared in first month. The residual VSD altered from 30% to 10%, and closure rate was 80% at the first month of observation. VSD closure with Nit-Occlud Le VSD coil provides good efficacy and safety for patients. Keywords: VSD, Nit-Occlud Le VSD coil

WEBINAR TRAINING OF EARLY DETECTION OF CONGENITAL HEART DISEASE FOLLOWED BY ECHOCARDIOGRAPHY AND PULSE OXIMETRY SCREENING IN LUMAJANG, EAST JAVA, INDONESIA

Congenital heart disease (CHD) affects about 0.8% to 1.2% with the mortality rate being 81 cases per 100,000 live births. Generally, CHD is a structural abnormality of the heart and (or) large blood vessels that appear at birth. The purpose of this activity is to conduct webinar training on early detection of congenital heart disease followed by ecocardiography and oximetry pulse screening in lumajang east Java Indonesia the novelty in this service activity because it provides training on early detection of heart disease. The training method was carried out through webinars with health worker participants in Lumajang. The material provided includes early detection methods, diagnosis and therapy, as well as simulations of CHD cases. Pre and Post-test are used to evaluate the level of knowledge. A visit to the echocardiography and pulse oximetry examination by a pediatric cardiologist was carried out two weeks later in Lumajang. As a result of the activity, there were 140 participants who took part in the webinar training. The average score of the pre-test was 11.13/15 with only 5 participants getting a perfect score. At the end of the webinar, the average post-test score was 14.34/15 with 115 participants who finally got a perfect score. A total of 28 children were examined by echocardiography examination. 20 children were diagnosed with cyanotic CHD, 6 children were diagnosed with cyanotic CHD, and 2 were normal children. On pulse oximetry examination, all babies had an oxygen saturation of 95% or more and there was no difference of more than 3% between the pre and post duct sites. Conclusion Webinar training can increase health workers' knowledge about early detection of CHD.Keywords : Congenital Heart Disease; Filtering; Echocardiography; Pulse oximetry

The effect of pomegranate extract against Endothelin-1 expression, inducible nitric oxide synthase, Dan thickness of smooth muscles in pulmonary artery media tunics

Background: Congenital Heart Disease which if not corrected on time can result in increased pulmonary artery pressure or what is referred to as Pulmonary Artery Hypertension (HAP). The pathogenesis of HAP involves remodeling of the pulmonary artery Pomegranate extract (EBD) can be developed as a therapy in cardiovascular disease as anti-proliferation and anti-inflammatory. Purpose: Analyzing the effect of pomegranate extract administration on the expression of Endothelin-1 (ET-1), Inducible Nitric Oxide Synthase (iNOS), and thickness of the tunica smooth muscle media of pulmonary arteries in rats modeled by pulmonary arterial hypertension. Method: This study was an observational analytic retrospective cohort study design. Analysis of the data used is a descriptive analysis of the number of cells expressing ET-1 and iNOS as well as the thickness of the tunica smooth muscle media of the pulmonary arteries for each group. Result: In the HAP model mouse group that was given EBD, the average number of cells expressing ET-1 decreased sharply from observation after 2 weeks to observation after 4 weeks. The mean number of cells expressing iNOS and the mean thickness of smooth muscle of the pulmonary artery also experienced a sharp decline from observation after 2 weeks to observation after 4 weeks. Conclusion: The administration of EBD can reduce the expression of ET-1, iNOS, and smooth muscle thickness in tunica pulmonary artery media in hypertensive mice

Deteksi Dini Penyakit Jantung Bawaan Melalui Pelatihan Webinar dan Screening Echocardiography di Kediri

Penyakit jantung bawaan (PJB) merupakan penyakit bawaan lahir yang paling banyak menimbulkan kematian. Kurangnya pengetahuan pada tenaga kesehatan menjadi hambatan dalam pencegahan dan deteksi dini PJB. Kegiatan edukasi yang bertujuan untuk meningkatkan pengetahuan tenaga kesehatan dalam melakukan deteksi dini dan penanganan PJB di Kediri perlu dilakukan. Kegiatan ini meliputi pelatihan webinar dan screening echocardiography dengan peserta tenaga kesehatan di Kediri. Tingkat pengetahuan peserta dinilai dengan pre-test dan post-test. Selanjutnya dilakukan screening echocardiography oleh Dokter Spesialis Anak Konsultan Jantung. Webinar diikuti oleh 451 peserta. Skor rata-rata pre-test adalah 5,80/15 dan skor rata-rata post-test adalah 12,84/15. Sebanyak 29 anak dilakukan pemeriksaan echocardiography. Terdapat 19 (65,52%) anak yang didiagnosis dengan PJB asianotik, 4 (13,79%) anak dengan PJB sianotik, dan 6 (20,68%) anak normal. Pelatihan webinar dapat meningkatkan pengetahuan tenaga kesehatan tentang deteksi dini PJB dan 79,31% anak yang telah dilakukan screening echocardiography didiagnosis dengan PJB di Kediri

The improvement chest x-ray after carvedilol therapy in heart failure due to left to right shunt, congenital heart disease

Background: Heart failure due to left to right shunt congenital heart defect will increase pulmonary blood flow and cause volume overload. This condition activated the sympathetic nervous system and the renin-angiotensin-aldosteron system. Conventional therapy has not blocked the sympathetic system yet. Carvedilol, a novel non selective β-blocker, reduced mortality and hospitalization in adults with heart failure. Limited information was available about its use in children. Objective: To evaluate the effect of carvedilol on chest x-ray in children with heart failure due to left to right shunt congenital heart defect. Methods: A randomized, double-blind, placebo-controlled study was done. In addition to conventional therapy, patients were assigned to receive placebo or carvedilol. Carvedilol was initiated at a dose of 0.05 mg/kg/day, with a target dose of 0.2 mg/kg/day. Chest x-ray was done before-after treatment and evaluated for cardio-thoracic ratio and pulmonary vascularity. The data was analyzed using independent sample t-test and Chi-square test, with confidence interval 95%. Results: Of 30 patients, 15 in each group. The mean age was 57.6(SD 43.57) months, 19(63.3%) were boys. There were 21(70%) children with VSD and 9(30%) children with PDA. Compared to control group, children in the carvedilol group had a significant decrease of cardio-thoracic ratio(-2.94?2.34% versus -0.48?3.19%, p=0.023, CI 95%:-4.556 to-0.360). However, there was no significant change of pulmonary vascularity(p=0.153). Conclusion: Carvedilol decreased the cardio-thoracic ratio on chest x-ray, but did not improve the pulmonary vascularity in children with heart failure due to left to right shunt Congenital heart defect

Vitamin D and cathelicidin assessment in children with pneumonia

Abstract Introduction: Pneumonia is a lung infection that becoming one of the most causes of death in children in developing countries. A deficiency of vitamin D has been suggested in several research had a potential role in reducing cathelicidin production. It is a peptide that could act as an anti-microbial agent. Thus this research aimed to analyze the effect of vitamin D supplementation on serum cathelicidin levels. Method: This study was a quasi-experimental, pretest-posttest control group double-blinded design conducted in the pediatric inpatient ward of General Hospital Dr. Soetomo Surabaya. The inclusion criteria of the sample were children that have been diagnosed with pneumonia clinically, and the ages must range from 1 month up to 5 years old. An oral single dose of 100,000 IU of vitamin D (cholecalciferol) has been administered to the participant, on the day of enrolment after the collection of the blood samples. Cathelicidin and calcidiol (25-hydroxyvitamin D) levels were obtained. Supplementation with oral vitamin D3 (cholecalciferol) at 100,000 IU single dose and placebo was given. At 8 days, all subjects had repeat serum cathelicidin and vitamin D levels. All of the data were annyalsis in SPSS ver 25. We analyze the data descriptively and analytically. For the analytic analysis, we analyze the data by man-witney and paired t-test. Results: Forty-six subjects were consisting in this study consisting of 23 cases and 23 controls, 30/46 were males and 16/46 were females. The median age in the study was 24 months. The mean levels of cathelicidin in the post-supplementation treatment group were 11.80 + 11.40 with p value= 1.00. Meanwhile, the mean level of cathelicidin in the placebo group after giving the placebo was 8.81 + 6.46 with p val ue= 0.29. Conclusion: Enhancement of vitamin D in children with pneumonia after giving the supplementation has been established. Meanwhile, only calcidiol serum level was to be significant in difference when comparing the pre and post-examination of the vitamin D supplementation group

Corresponding Behavioral Problems among Type 1 Diabetes Mellitus Children with Good and Poor Metabolic Control During COVID-19 Pandemic

Background: Children with type-1 diabetes mellitus (T1DM) often experience emotional and behavioral problems such as anxiety and depression. Social restrictions during the COVID-19 pandemic caused social restrictions and limited access to healthcare facili- ties, which may have worsened the metabolic control. Objectives: This study aimed to analyze the behavioral problems among type 1 diabetes mellitus children with good and poor metabolic control during COVID-19 pandemic. Methods: This cross-sectional study was conducted in January - August 2021 in the Endocrine Outpatient Clinic of General Hospital Dr. Soetomo Surabaya. Type-1-DM children who fulfilled the inclusion criteria were divided into two groups based on metabolic control, including good (HbA1C ≤ 8) and poor (HbA1C > 8). The Pediatric Symptom Checklist-17 (PSC-17) was used as a screening tool with the domain internalizing problems (IP), externalizing problems (EP), and attention problems (AP). The data were analyzed using Pearson or Spearman test with Statistical Product and Service Solution (SPSS) version 18.0. Results: In this study, 27 subjects (17 boys and 10 girls, aged 12.63 ± 3.39 years) were investigated. Of all subjects, only 8 subjects had good metabolic control during the COVID-19 pandemic. Furthermore, 33.3% of the participants had behavioral problems (14.8% IP; 18.5% EP). The frequencies of IP, EP, and AP in the good metabolic control group were 12.5%, 37.5%, and 0%, respectively; while those in the poor metabolic group were 15.8%, 10.5%, and 0%, respectively. There was no significant difference between the good and poor metabolic control groups in terms of behavior problems (P = 1.00, IP; P = 0.14, EP). Conclusions: No significant difference was found between good and poor metabolic control groups (P = 1.00, IP; P = 0.14, EP). How- ever, the frequency of EP was higher in good metabolic control, and the frequency of IP was higher in poor metabolic control

Potention of L-carnitine supplementation on changes in ejection fraction and left ventricular dimension in case of dilatative cardiomyopathy in children

Background: Cardiomyopathy is a rare cardiac muscle disease with poor prognosis and high mortality. The main goal of dilated cardiomyopathy therapy is to restore and maximize cardiac function, but to date no medication has met these criteria. The use of oral L-carnitine as a dilated cardiomyopathy therapy has a potency to gives good results in restore and maximize cardiac function. Purpose: Knowing the effect of L-carnitine supplementation in children with cardiomyopathy on ejection fraction and left ventricular dimensions. Method: Experimental studies with randomized control trial design were conducted for one year, to determine the effect of L-carnitine in the experiment by performing twice the ejection fraction measurements and left ventricular dimensions performed before and after the administration of L-carnitine for 1 month. This research does not use blind method. Sampling was done randomly with comparison control. Different test was conducted with Saphiro-Wilk followed by T-test. Result: Fourteen samples were analyzed. In the treatment group, an increase in ejection fraction (p = 0.033), decreased left ventricular systolic phase end dimension (p = 0.043) and at the end of diastolic phase (p = 0.170). There was a significant difference in the increase of ejection fraction between treatment group and control group (p = 0,035), but no significant difference was found between treatment group and control group of final phase of systole (p = 0,228) and final phase of diastol (p = 0,704). Conclusion: L-carnitine supplementation in children with dilatative cardiomyopathy can increase ejection fraction, but not decrease the left ventricular dimension

The Expressions of Some Growth Factors as the Progressive Indicators of Pulmonary Arterial Hypertension

Vasoconstriction is commonly regarded as the cause of pulmonary arterial hypertension (PAH), but another cause that cannot be ignored is artery wall remodeling marked by the thickening of tunica intima, media, and adventitia. Several parameters’ expressions indicating PAH include basic fibroblast growth factor-2 (bFGF-2), transforming growth factor-ẞ1 (TGF-ẞ1), matrix metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinase-1 (TIMP-1), and type 1 collagen. This study aims to verify the progressive increase in the expression of bFGF-2, TGF-β1, TIMP-1, and type 1 collagen, the decrease of MMP-2 expression, as well as the MMP-2:TIMP-1 ratio in the tunica adventitia of pulmonary arteries. The samples of paraffin blocks in rat models’ lung tissue of pulmonary arterial hypertension were made in a particular time span. The immunohistochemical method was employed to examine the expressions of bFGF-2, TGF-β1, MMP-2, TIMP-1, and type 1 collagen. The data analysis was carried out using the Pearson and Spearman statistical test. After 28-day observation, the number of cells expressing bFGF-2, TGF-β1, TIMP-1, progressively increased and had a strong, positive and significant correlation with the time reaching p-value of 0.005, 0.000, and 0.000 respectively. Meanwhile, MMP-2 and MMP-2:TIMP-1 ratio had a weak negative and insignificant correlation with the time. In tunica adventitia of pulmonary arteries on rat models of pulmonary arterial hypertension induced with monocrotaline, it is proven that there is a progressive increase in the expression of bFGF-2, TGF-β1, TIMP-1, and type 1 collagen. In addition, MMP-2 expression suggests a progressive decrease, while the MMP-2:TIMP-1 ratio also decreases