Association of Growth Velocity with Insulin-Like Growth Factor-1 and Insulin-Like Growth Factor Binding Protein-3 Levels in Children with a Vegan Diet

Background: The vegan diet in children provides the benefit of reducing the risk of being overweight and improving the fat profile. The risk that can occur in the provision of a vegan diet in children is anthropometric size below reference and low caloric intake. Growth hormone (GH) and Insulin like Growth Factors (IGFs) are powerful stimulators for longitudinal growth of bone and require insulin-like growth factor binding protein (IGFBPs) which acts as a transport protein for IGF-1. A vegan diet with lower calorie intake in children has lower IGF-I levels than children with an omnivorous diet.Objective: Examining the effect of vegan diets on IGF-1 levels, IGFBP-3 levels, and growth velocity.Methods: This study was done with a prospective cohort design. The study subjects were divided into two groups, namely the vegan group and the omnivorous group, then matched based on age and sex. During the study, anthropometric data collection, IGF-1 and IGFBP-3 levels measurements were done in both vegan children and omnivorous children.Results: During 6 months of observation, 22 subjects were divided into two groups, namely children with a vegan diet and children with an omnivorous diet. IGF-1 (ng / mL) in vegan children was 105.5 ± 47.3 compared to 102.7 ± 42.3 in omnivorous children with a value of p = 0.89. IGFBP-3 (ng / mL) in vegan children was 2146.4 ± 595.1 compared to 2142 ± 609.1 in omnivorous children with value of p = 0.99 and Growth Velocity (cm / 6 months) was 3.0 in vegan children (1.0-5.30), and 3.2 (2.6-6.5) in omnivorous children with value of p = 0.41.Conclusion:Children with vegan diet had IGF-1 level, IGFBP-3 level, and growth velocity that were the same as children with an omnivorous diet

THE ROLE OF UROLOGISTS IN MANAGEMENT OF DISORDERS OF SEX DEVELOPMENT

Objective: To evaluate disorder of sex development (DSD) profile at Cipto Mangunkusumo Hospital (RSCM), the management profile, and the role of urologist on diagnostic and therapeutic management. Material & method: We retrospectively collected data from medical record of all DSD cases managed by pediatric endocrinologist, urologist, obstetric gynaecologist at RSCM from January 2002 up to December 2009. 2006 IICP criteria was used as classification. The management profile and the role of urologist were evaluated. Results: there were 133 DSD cases with the majority of cases was congenital adrenal hyperplasia (CAH) followed by androgen insensitivity syndrome (AIS). Most of the cases were diagnosed before one year old and other on pubertal period. Karyotyping, laboratory examination, ultrasonography, genitography, uretrocystoscopy, kolposcopy, diagnostic laparascopy were performed as diagnostic management. Gender assignment was performed by multidisciplinary team. Masculinizing surgery, feminizing surgery, and gonadectomy was done as therapeutic management. Conclusion: The majority case on RSCM’s DSD profile was CAH. The management was performed by multidisciplinary team. Gender assignment decision should be based upon thorough diagnostic evaluation. The urologist has important role on diagnostic and therapeutic management. Keywords: Disorder of sex development, diagnostic management, gender assignment, therapeutic management, urologist

Acanthosis Nigricans dan Hubungannya dengan Resistensi Insulin pada Anak dan Remaja

Acanthosis nigricans (AN) bukan hanya sekedar kelainan kulit saja, tetapi dipandang sebagai petanda adanya penyakit lain yang mendasari, salah satunya adalah resistensi insulin. Prevalensi AN bervariasi dari 7% pada populasi umum sampai dengan 74% pada orang dengan obesitas. Penelitian terakhir memperlihatkan bahwa derajat beratnya AN berhubungan dengan konsentrasi insulin plasma puasa dan indeks masa tubuh (IMT). Tidak ada perbedaan insidens antara laki-laki dan perempuan. Secara garis besar AN dibagi menjadi dua kategori besar yaitu jinak (benign) dan ganas (malignant). Acanthosis nigricans pada sindrom resistensi insulin disebabkan karena kadar insulin yang tinggi mampu mengaktifkan fibroblas dermal dan keratinosit melalui reseptor insulin-like growth factor yang ada pada sel-sel tersebut. Sebagai hasilnya terjadi peningkatan deposisi glikosaminoglikans oleh fibroblas di dermal. Hal ini menyebabkan papilomatosis dan hiperkeratosis. Acanthosis nigricans dilaporkan sebagai salah satu faktor prediktor hiperinsulinemia yang cukup baik. Skrining adanya AN merupakan alat yang cukup sederhana, cepat, mudah, dan murah untuk mendeteksi individu yang berisiko menderita diabetes tipe 2 dan penyakit lain yang berhubungan dengan hiperinsulinemia. Skrining AN di klinik dan sekolah untuk mengidentifikasi individu yang berisiko tinggi menderita diabetes tipe 2 memiliki implikasi penting dalam pengembangan strategi intervensi melawan DM, terutama di tingkat layanan primer.Tujuan terapi pada AN adalah untuk mengkoreksi penyakit yang mendasarinya. Koreksi hiperinsulinemia dapat mengurangi derajat lesi hiperkeratosis, begitu juga dengan penurunan berat badan

Adolescent Development (Perkembangan Remaja)

Adolescent atau remaja merupakan periode kritis peralihan dari anak menjadi dewasa. Pada remaja terjadi perubahan hormonal, fisik, psikologis maupun sosial yang berlangsung secara sekuensial. Pada anak perempuan awitan pubertas terjadi pada usia 8 tahun sedangkan anak laki-laki terjadi pada usia 9 tahun. Faktor genetik, nutrisi, dan faktor lingkungan lainnya dianggap berperan dalam awitan pubertas. Perubahan fisik yang terjadi pada periode pubertas ini juga diikuti oleh maturasi emosi dan psikis. Secara psikososial, pertumbuhan pada masa remaja (adolescent) dibagi dalam 3 tahap yaitu early, middle, dan late adolescent. Masing-masing tahapan memiliki karakteristik tersendiri. Segala sesuatu yang mengganggu proses maturasi fisik dan hormonal pada masa remaja ini dapat mempengaruhi perkembangan psikis dan emosi sehingga diperlukan pemahaman yang baik tentang proses perubahan yang terjadi pada remaja dari segala aspek

Audit of childhood diabetes control in Indonesia

Objectives To detennine the status of diabetes control in children and adolescents in Indonesia. Methods We collected data from seven pediatric diabetes centers in Indonesia from January to September 2001. Data were obtained either by patient interview during the enrollment visit or by reviewing medical records of the most recent clinical examination and treatment infonnation. Blood samples were also collected for the assessment of HbA1 c. Results Most patients recruited had type 1 diabetes (n=64, 93%) and the focus of this report was on this group. The mean of centrally measured HbA1C in the 60 type 1 patients was 10.5 (SO 2.7%) with 90% having values exceeding 7.5%, indicating inadequate glycemic control. The mean HbA1c was higher in patients older than 10 years but not necessarily in children with longer diabetes duration or older age of diabetes onset. The frequency of severe hypoglycemic or diabetic ketoacidosis was 75 and 20 per 100 patient-years, respectively. Severe hypoglycemia was higher in children younger than five years than those older. Chronic complications including microalbuminuria, neuropathy and retinopathy, were reported in older children but not necessarily in children with longer duration of diabetes or earlier age of diabetes onset. Glycemic control tended to be better for patients on thrice rather than twice daily insulin injections. However, only 12% were on three or four times daily insulin injection regimen compared to 88% who were on twice daily insulin injections. Conclusions The present audit shows that 90% of the type 1 and all of the type 2 patients did not achieve adequate glycemic control (HbA1c >7.5%). The frequency of severe hypoglycemia was higher in the younger children and glycemic control was worse in the older children

Practices of growth assessment in children: Is anthropometric measurement important?

Assessing and monitoring growth is common practice in pediatric care, and health professionals accept routine growth monitoring in children as a standard component of community child health services throughout the world. In clinical level, by these activities one can detect and intervene while growth faltering happens. The internationally recommended way to assess malnutrition at population level is to take anthropometric measurements. In developed countries, growth monitoring is an intrinsic part of ‘well child’ clinics. As growth is a proxy for child health, the child who grows well is generally healthy and illness in a child is usually associated with poor growth. Interpretation of child growth is based on anthropometric indicators established in a reference population with cut-off points to differentiate under- and overnutrition, short stature or tall stature, proportionate or disproportionate growth. Practices of growth monitoring consist of regularly measuring the weight and height of children, then plotting the information on a growth chart to make abnormal growth visible. When growth is abnormal, the health worker does something in concert with the family and as a result of these actions the child receives appropriate social or medical support, his or her nutrition improves, or a serious condition is diagnosed earlier

Pubertas Terlambat pada Thalassemia Mayor

Gangguan kelenjar endokrin akibat penimbunan besi pada pasien thalassemia mayor semakin sering ditemukan seiring dengan meningkatnya harapan hidup. Kegagalan pubertas merupakan komplikasi endokrin yang paling sering diikuti oleh amenore sekunder. Angka kejadian pubertas terambat pada thalassemia mayor bervariasi tergantung jenis kelamin, riwayat transfusi darah dan terapi kelasi besi yang pemah didapat, dan usia saat memulai terapi kelasi. Para peneliti mendapatkan kejadian pubertas terlambat lebih sering terjadi pada lakilaki. Secara umum, penyebab pubertas terlambat dikiasifikasikan menjadi gangguan temporer sekresi gonadotropin, dan steroid seks, kegagalan poros hipotalamus-hipofisis dengan defisiensi sekresi gonadotropin dan kegagalan gonad primer. Gangguan tersebut diakibatkan oleh proses peroksidasi lipid oleh penimbunan besi di dalam sel-sel kelenjar hipofisis dan kerusakan di hipofisis mi menyebabkan sekresi gonadotropin menurun. Secara klinis keterlambatan pubertas pada perempuan umumnya keterlambatan pertumbuhan payudara dan rambut pubis, sedang pada lakilaki terjadi gangguan perkembangan testis. Penting untuk melakukan pemeriksaan hormonal untuk mengetahui fungsi poros hipotalamus-hipofisis-gonad. Tatalaksana thalassemia mayor dengan pubertas terlambat selain terapi pengganti hormonal, perlu diperhatikan status nutrisi, dan pemberian transfusi disertai terapi kelasi yang adekuat

Effects of a structured educational intervention on metabolic control of type-1 diabetes mellitus patients

Background Children with type-1 diabetes face not only short- term complications but also long-term microvascular and macrovascular complications. Therefore, a continuing medical care and education to reach blood glucose near normal range is abso- lutely required. An addition of behavioral educational intervention to intensive diabetes management resulted in improved metabolic control and quality of life. Objective To determine the effects of a structured educational intervention to parents and patients with type-1 diabetes mellitus on their knowledge and patient metabolic control. Methods In this interventional study with pretest-posttest design at Department of Child Health, Medical School, University of Indo- nesia, a total of 21 patients with the age between 8 and 18 years and their parents were assigned to follow a structured educational program over period of 6 months. During the 6 intervention ses- sions, some procedures were applied: obtaining HbA1c at initial, 3 rd and 6 th month using HPLC procedure, classroom teaching pro- gram, small group discussions, role-playing and pre-posttests. Results The mean HbA1c level in the 21 children and adoles- cents at initial, 3 rd and 6 th month were 10.05% (SD 2.67%), 10.28% (SD 2.23%) and 10.01% (SD 2.67%), which showed no significant changes (P>0.05). After 6 educational sessions, the result showed significant changes in both parents’ (P<0.05) and patients’ knowl- edge (P<0.05). Patients’ diabetes-related knowledge had a mod- erate correlation (r=-0.632; P=0.02) , but parents’ diabetes-related knowledge had no significant correlation (r=-0.348; P=0.122) with patient mean HbA1c level. Conclusion A structured educational intervention used in this study is able to improve parents’ and patients’ diabetes-related knowl- edge significantly. Patients’ diabetes-related knowledge had a sig- nificant correlation with metabolic contro

Pengobatan Testosteron pada Mikropenis

Mikropenis atau hipogenitalism adalah suatu keadaan penis dengan bentuk normal namun dengan ukuran kurang dari 2.5 SD di bawah rerata menurut umur dan status perkembangan pubertas. Pengukuran penis dilakukan secara fully stretched, menggunakan spatula kayu yang diletakkan sejajar dengan dorsum penis dan ditekan sampai simfisis pubis. Panjang penis adalah jarak dari simfisis pubis sampai ujung glans penis dan tidak dalam keadaan ereksi. Pengobatan mikropenis terhadap 23 anak dengan rerata usia 9.6 tahun dilakukan dengan pemberian testosteron ester intramuskular setiap 3 minggu sebanyak 4 kali. Pasca terapi penis bertambah panjang 85% dibandingkan sebelum terapi. Tidak terlihat adanya pertambahan usia tulang dengan protokol yang digunakan