Association of ferritin level with attention deficit hyperactivity disorder in children

Background: Dopamine is an important component in the pathophysiology of ADHD. Dopamine synthesis is regulated by the enzyme tyrosine hydroxylase and influenced by iron deposits in the brain. Several studies have shown that low ferritin levels in children with ADHD and iron supplementation are said to show good clinical outcomes, but this study has never been conducted at Sanglah General Hospital.Methods: This study used an observational analytic study design with unpaired case control design. Research held in Policlinic RSUP Sanglah from July 2018 to April 2019.Results: In a total of 25 children with ADHD and 25 children without ADHD, median ferritin level was 43.7(7.9-77.0) in the case group and 68.2(33.1-319.0) in control group. Bivariate analysis of ferritin level categories using the chi-square test showed significantly different results. Low ferritin levels (<45 ng/mL) was obtained in 56% of the case group and 16% in the control group. Odd ratios determine the relationship between ferritin and the incidence of ADHD at 6.7 (95% KI 1.8-25.2). The results of multivariate analysis showed that adjusted OR was 6.5(95% KI 1.2-34.6) and was statistically significant with p value 0.027.Conclusions: There was correlation between ferritin levels and ADHD in children

Correlation between Serum Level of Matrix Metalloproteinase-2 with Left Ventricular End-diastolic Volume in Children with Heart Failure

BACKGROUND: Left ventricular end-diastolic volume (LVEDV) on echocardiography is one of the tests performed on heart failure. This refers to the volume of the left ventricle at the end of the diastolic phase, which would be increased when there is a disturbance in preload, afterload, and contractility factors. Matrix metalloproteinase-2 (MMP2) is a marker of congestive heart failure that can be examined through laboratory examinations. AIM: The objective of the study was to provide evidence of the association between MMP and inflammatory process as well as its correlation with LVEDV in children with heart failure. METHODS: This was a cross-sectional study conducted on children aged 3 months–12 years old with heart failure, who visited Sanglah Hospital, Denpasar, Indonesia from May 2017 to March 2018. Echocardiographic examination (LVEDV) and blood samples were taken to measure the serum level of MMP2 on day 1 after the subjects were diagnosed with heart failure. RESULTS: A total of 32 subjects with heart failure were analyzed in this study. Acyanotic congenital heart defect (CHD) was the most common cause of heart failure, as observed in 23 subjects (71.9%). Characteristics data revealed that 24 subjects (75%) were underweight, 23 (71.9%) had cardiomegaly, and 22 (68.8%) had mild heart failure. Data analysis showed a moderate positive correlation between MMP2 levels with LVEDV after controlling for the influence of age (p = 0.02; r = 0.425). CONCLUSION: There was a moderate positive correlation between MMP2 level and LVEDV after controlling for the age factor

Liver function in children with human immunodeficiency virus infection before and after 6 months of highly active antiretroviral therapy

Background Highly active antiretroviral therapy (HAART) has resulted in dramatic decreases in morbidity and improved survival rate in human immunodeficiency virus (HIV)-infected patients. Although the risk of morbidity has decreased, it has been replaced by other long-term complications, such as hepatotoxicity. Hepatotoxicity is often reflected in biochemical abnormalities of liver function, such as elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and aspartate aminotransferase-to-platelet ratio index (APRI). Objective To compare liver function spectrum (AST, ALT, and APRI) in HIV-infected children before and after at least 6 months of HAART. Methods This observational study (before and after) was conducted in pediatric patients with HIV infection who received HAART for at least 6 months at Sanglah Hospital, Denpasar. Data were collected from medical records. Results Forty-nine patients were observed in this study. The mean AST, ALT, and APRI levels before HAART were higher than after at least 6 months of HAART. Anti-tuberculosis treatment and fluconazole therapy were not confounding factors for AST, ALT, and APRI. Conclusion Liver function spectrum enzyme levels of AST, ALT, and APRI are improved after at least 6 months of HAART

The value of IgG to IgM ratio in predicting secondary dengue infection

Background The determination of primary or secondary dengue infection using hemagglutination inhibition (HI) test is time-con- suming. The IgG to IgM ratio which can be obtained earlier was used by several studies to differentiate secondary from primary infection, but they still reported various cut-off points. Objective To find the diagnostic value and best cut off point of IgG to IgM ratio for predicting secondary dengue infection. Methods This was a prospective study carried out between July 2003 and June 2004. Children with suspected dengue hemor- rhagic fever (DHF) were tested for HI during acute and convales- cent phase. The IgG and IgM titer were examined during the acute phase using ELISA method. Results Sixty-two children were recruited, 48 with secondary in- fection and 14 with primary infection. The prevalence of second- ary infection was 77%. The best cut off point of the IgG to IgM ratio to predict secondary infection was >1.1 with sensitivity of 87.5%, specificity 92.9%, likelihood ratio 12.3, and post test probability 97.7%. Conclusion The IgG to IgM ratio of >1.1 is a good predictor for secondary infectio

Kolestasis pada Sepsis Neonatorum di RSUP Sanglah, Denpasar

Latar belakang. Kolestasis neonatal masih merupakan permasalahan dibidang ilmu kesehatan anak. Angka kejadian kolestasis intrahepatal yang disebabkan oleh sepsis sebesar 65,9% dengan angka kematian pada neonatus 52,8%. Tujuan.Mengetahui prevalensi dan luaran, faktor berhubungan dengan kejadian kolestasis pada sepsis neonatorum. Metode.Desain potong lintang analitik pada neonatus terbukti sepsis, pengambilan data rekam medik dari Januari 2008 sampai dengan September 2010. Hasil. Prevalensi kolestasis 38,9% dengan penyebab terbanyak bakteri Gram negatif yaitu Serratia Marcescens (19,2%). Lama rawat t15 hari kolestasis dengan RR 1,57 (IK 95% 0,029-0,116), rerata lama puasa 8,8 hari ±6,81), p=0,001, rerata lama pemberian nutrisi parenteral 14,2 hari (SD=8,26), p=0,001 merupakan faktor yang signifikan untuk terjadi kolestasis. Kadar rerata CRP 97,51 (74,94), kadar IT ratio 0,07 (0,05), kadar trombosit 60.250 (60,950) bermakna berhubungan dengan kolestasis. Mortalitas pada sepsis neonatorum dengan kolestasis 23,3%. Kesimpulan.Prevalensi kolestasis pada sepsis neonatorum di RSUP Sanglah Denpasar didapatkan 38,9%. Faktor lama rawat t15 hari, lama puasa serta pemberian nutrisi parenteral dan rerata kadar CRP, IT ratio, serta kadar trombosit bermakna untuk terjadi kolestasis, dan angka kematian sepsis neonatorum dengan kolestasis 9%

Efficacy of synbiotic treatment in children with acute rotavirus diarrhea

Background Diarrhea is one of the major causes of morbidity and mortality in children throughout the world, mostly due to rotavirus infection. In daily practice, we routinely use the World Health Organization Five steps for managing acute diarrhea.This practice has shown great success in diarrhea management, but concerns remain on reducing the duration of diarrhea to prevent complications. Synbiotics can reduce the severity of diarrhea. However, there has been limited data on synbiotic therapy for treating acute rotavirus diarrhea in children. Objective To compare the durations of acute rotavirus diarrhea treated with synbiotics vs. placebo. Methods This study was a randomized, double-blind, clinical trial, performed at the Pediatric Gastrohepatology Division, Sanglah and Wangaya Hospitals in Denpasar. Subjects were children aged 6 to 59 months with acute rotavirus diarrhea. Rotavirus was diagnosed by immune chromatography assay. The synbiotic group received probiotic comprised of Lactobacillus sp., Streptococcus sp., Bifidobacterium sp. (total viable count 1.00x109 CFU per dose), and prebiotic consisted of 990.00 mg fructooligosacharide (FOS). The placebo consisted of lactose monohydrate packaged similarly as the synbiotics. Subjects orally ingested 1 pack per day for 5 days. Results Seventy children with acute rotavirus diarrhea was involved in this study. The median duration of diarrhea in the synbiotic group was 50.0 (SE 1.1); 95%CI 47.9 to 52.1 hours, while that of the placebo group was 63.0 (SE 5.9); 95%CI 51.4 to 74.6 hours. Based on Kaplan-Meier survival analysis, the duration of diarrhea in the synbiotic group was significantly shorter than that of the placebo group (log-rank test P <0.0001). Conclusion In children with acute rotaviral diarrhea, synbiotic reduces the duration of diarrhea compared to placebo

Pengaruh Formula Bebas Laktosa Terhadap Lama Diare dan Elektrolit Serum pada Anak dengan Diare Rotavirus

Latar belakang.Diare akut rotavirus menyebabkan kerusakan mukosa, vili usus menjadi tumpul dan pendek, serta kematian sel. Proses tersebut juga mengurangi sekresi enzim laktosa yang bertanggung jawab dalam penyerapan laktosa. Laktosa yang tidak terserap menyebabkan berkembangnya diare osmotik yang mengakibatkan kehilangan cairan dan elektrolit. Formula bebas laktosa dapat diserap tanpa membutuhkan enzim laktose, sehingga lama dari episode diare dapat dipersingkat. Tujuan.Untuk membandingkan lama diare dan elektrolit serum pada bayi dan anak dengan diare rotavirus setelah pemberian nutrisi formula bebas laktosa dibandingkan dengan formula standar. Metode.Uji klinis acak terkontrol tersamar ganda desain pararel, pada anak usia t6-d59 bulan dengan diare akut, dibagi 2 kelompok dengan besar sampel masing-masing 30 (kelompok A formula bebas laktosa; B formula standar). Latex agglutination testdigunakan untuk mendeteksi rotavirus. Setelah dilakukan rehidrasi, diberikan intervensi. Observasi dilakukan tiap 6 jam untuk mengetahui durasi diare, berat badan, dan frekuensi defekasi. Analisis statistik dengan paireddanindependent t-testdan analisis multivariat (cox regression). Hasil. Rerata lama diare pada kelompok bebas laktosa 57,59 jam (SB 9,40) dan formula standar 85,97 (SB 13,94) jam, dengan beda rerata 28,38 (SE 3,09) jam (IK95% 22,19;34,56; p=0,001). Penurunan frekuensi defekasi bermakna pada kelompok bebas laktosa, tetapi tidak bermakna pada peningkatan berat badan. Analisis multivariat menunjukkan hanya intervensi yang diberikan berpengaruh secara bermakna terhadap lama diare diare. Rerata peningkatan serum elektrolit hanya bermakna pada serum natrium, yaitu pada kelompok formula bebas laktosa dengan rerata 1,62 (SB4,20) mEq/L (IK95% -2,83;0,41; p=0,01). Kesimpulan. Formula bebas laktosa dapat mempersingkat lama diare dan meningkatkan kadar serum natrium pada diare rotavirus

Toilet training and less fiber consumption as risk factors of constipation in preschool children

This study aimed to determine the prevalence and risk factors for children with constipation. This research was an analytic cross-sectional study. The sampling method was cluster sampling. The research was conducted at some kindergartens in Denpasar, Bali from October to November 2019. Data were obtained based on questionnaires distributed to parents and anthropometric examinations. Constipation was defined according to The Rome IV criteria. There were 215 children included in the study and 43 (20%) children had constipation. Children who started toilet training before the age of 1.5 years or after 2 years had 2,73 times the risk of developing constipation (p = 0.019; 95% CI 1.18-6.3). Children with less fiber consumption in a day had the risk of experiencing constipation 7.25 times (p = 0.001; 95% CI 3.38-15.5). Other risk factors such as sex, physical activity, screen contact, water consumption, nutritional status, birth weight, and mother education did not statistically relate to constipation. Toilet training before the age of 1.5 years or after 2 years and low fiber consumption are risk factors for constipation in preschool children in Denpasar