Exposure to cow’s milk as a prognostic factor for atopic dermatitis during the first three months of life

Background The incidence of atopic dermatitis has increased in the early life of children. Cow's milk, the first foreign protein to which infants are exposed, is predicted to be a prognostic factor of atopic dermatitis. Objective To determine if exposure to cow's milk is a prognostic factor for atopic dermatitis during the first three months oflife. Methods We performed a cohort study involving 136 newborns from families with and without histories of atopy in Sanglah Hospital, Denpasar, between April to August 20 12. Subjects were allocated into 2 groups, those who were exposed to cow's milk (n=68) and not exposed to cow's milk (n=68). We analyzed the impact of several possible prognostic variables on atopic dermatitis at 3 months of age including exposure to cow's milk, birth weight, sex, gestational age, exposure to cigarette smoke, early solid feeding, and history of atopy in the mother, the father, or both, as well as maternal consumption of chicken eggs when nursing. Data were analyzed with Cox's proportional hazard function. The cumulative incidence and incidence rate in each group were calculated. Results Exposure to cow's milk in the first 3 months of life resulted in a cumulative incidence of atopic dermatitis of 17 .6%, with an incidence rate of atopic dermatitis of 54.5%. However, multivariate analysis showed that cow's milk exposure was not a significant prognostic factor for atopic dermatitis (HR 1.3 7; 95%CI 0.22 to 8.43). Conclusion Cow's milk exposure is not a prognostic factor of atopic dermatitis during the first three months of lif

Correlation of Capute Scores with CD4 Count among Human Immunodeficiency Virus-infected Children in Sanglah Hospital, Bali, Indonesia

BACKGROUND: Cognitive, motoric, and language development in a human immunodeficiency virus (HIV)-infected child is an important issue that affects developmental milestone and quality of life. The effect of HIV infection on cognitive function must be detected early to prevent delayed cognitive, motoric, and language function. AIM: This study aimed to assess the correlation of cognitive scores with CD4 count among HIV-infected children in pediatrics polyclinic Sanglah Hospital, Bali. METHODS: This cross-sectional study recruited 68 HIV-infected children age 0–36 months old as participants. Cognitive score was assessed using Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) scores and HIV status, and CD4 count was obtained from the medical record. RESULTS: The result showed that mean of CD4 count among subject was 29.85 cells/mm3, there was positive correlation between CAT scores with CD4 count (r = 0.33, p = 0.006) and also between CLAMS scores with CD4 count (r = 0.307, p = 0.01). CONCLUSION: It can be concluded that CD4 count correlated with Capute scores on HIV-infected children

Using comic, pictograms and table sticker to improve knowledge and medication adherence in children

Adherence to treatment of chronic diseases is one of the main things to ensure the success of therapy. Children with chronic disease, often not adhere to their treatment. One of the problem of non-adherence is due to the lack of information which given to the children about their treatment. This study aims to determine the effectiveness of education to improve knowl edge and adherence in children with HIVIAIDS

Partially Hydrolyzed Whey Protein: A Review of Current Evidence, Implementation, and Further Directions

Background: Human milk is known to be the best nutrition for infants as it provides many health benefits. For non-breastfed infants, cow's milk based infant formula is the most optimal option to provide the needed nutrition. However, approximately 2-5% of all formula-fed infants experience cow’s milk allergy during their first year of life. Partially hydrolyzed whey formula (pHF-W) have been widely recommended to prevent the development of allergic disease in infants. However, according to epidemiological data, approximately half of the infants developing allergy are not part of the at-risk group.Objectives and Methods: This article aims to review the effects of pHF-W in preventing allergy, especially atopic disease, in all non-breastfed infants, as well as the safety aspect of pHF-W if used as routine formula. The role of pHF-W in the management of functional gastro-intestinal (GI) disorders is also reviewed.Results: Several clinical studies showed that pHF-W decrease the number of infants with eczema. The strongest evidence is provided by the 15-year follow up of the German Infant Nutritional Intervention study which showed reduction in the cumulative incidence of eczema and allergic rhinitis in pHF-W (OR 0.75, 95% CI 0.59-0.96 for eczema; OR 0.67, 95% CI 0.47-0.95 for allergic rhinitis) and casein extensively hydrolysed formula  group (OR 0.60, 95% CI 0.46-0.77 for eczema; OR 0.59, 95% CI 0.41-0.84 for allergic rhinitis), compared to CMF as a control, after 15 years of follow-up. pHF-W was also found to be beneficial in the management of functional GI disorders such as regurgitation, constipation and colic.Conclusions: The use of pHF-W in allergic infants has been recommended in various guidelines across the countries, as a primary prevention of allergic disease. One pHF-W has been approved by the US FDA and the European Commission's European Food Safety Authority (EFSA) for its safety and suitability as a routine infant formula for all healthy infants. According to the data obtained in the management of functional GI disorders, pHF-W is better tolerated than formula with intact protein. Further studies assessing the effect of routine use of pHF-W in a larger population of non-breastfed infants should also be conducted, in order to observe any potential harm and to determine the benefit and cost-effectiveness ratio

Age and HIV stage at initiation of highly active antiretroviral therapy determine non-reversal of stunting at 3 years of treatment

Background Highly active antiretroviral therapy (HAART) has been reported to improve growth, especially in the first 2 years of treatment. It is not clear whether catch up growth is maintained after 2 years of HAART. Objective To assess growth in stunted children with HIV after 3 years of HAART and analyze possible risk factors for non-reversal of stunting. Methods This study was done from May 2016 to April 2017 to follow children with HIV who started HAART between January 2009 and April 2014, and continued for 3 years. Inclusion criteria were children with HIV, aged < 18 years, compliance to the regimen, and stunting. Exclusion criteria were patients lost to follow up or who died prior to 3 years of HAART. Non-reversal of stunting was defined as HAZ ≤ -2SD after 3 years of HAART. Possible risk factors for non-reversal were analyzed using Chi-square test with P<0.05, as well as risk ratio (RR) and 95% confidence intervals (CI). Results Of 150 HIV-infected pediatric patients, 115 were on HAART and 55 (47.8%) were stunted at HAART initiation. Of the 55 stunted and HAART-treated children, 31 (56.4%) were male. Baseline median age was 3.6 years (interquartile range 0.37-8.48). Non-reversal occurred in 32 (58.2%) subjects. Multivariate Cox regression model analysis showed predictors of non-reversal after 3 years of HAART to be age >2 years (RR 16.05; 95%CI 2.89 to 89.02; P=0.002) and HIV stage III-IV (RR 8.93; 95%CI 1.47 to 54.37; P=0.017). Conclusion HAART initiation at age >2 years and HIV clinical stage III-IV at diagnosis are risk factors for non-reversal of stunting after 3 years of HAART

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

Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and Screening Practices

Background The global burden of childhood tuberculosis (TB) is estimated to be 0.5 million new cases per year. Human immunodeficiency virus (HIV)-infected children are at high risk for TB. Diagnosis of TB in HIV-infected children remains a major challenge. Methods We describe TB diagnosis and screening practices of pediatric antiretroviral treatment (ART) programs in Africa, Asia, the Caribbean, and Central and South America. We used web-based questionnaires to collect data on ART programs and patients seen from March to July 2012. Forty-three ART programs treating children in 23 countries participated in the study. Results Sputum microscopy and chest Radiograph were available at all programs, mycobacterial culture in 40 (93%) sites, gastric aspiration in 27 (63%), induced sputum in 23 (54%), and Xpert MTB/RIF in 16 (37%) sites. Screening practices to exclude active TB before starting ART included contact history in 41 sites (84%), symptom screening in 38 (88%), and chest Radiograph in 34 sites (79%). The use of diagnostic tools was examined among 146 children diagnosed with TB during the study period. Chest Radiograph was used in 125 (86%) children, sputum microscopy in 76 (52%), induced sputum microscopy in 38 (26%), gastric aspirate microscopy in 35 (24%), culture in 25 (17%), and Xpert MTB/RIF in 11 (8%) children. Conclusions Induced sputum and Xpert MTB/RIF were infrequently available to diagnose childhood TB, and screening was largely based on symptom identification. There is an urgent need to improve the capacity of ART programs in low- and middle-income countries to exclude and diagnose TB in HIV-infected childre

Using family atopy scores to identify the risk of atopic dermatitis in infants

Background Atopic dermatitis is the first manifestation of allergic disease in early life. Early interventions may prevent the development of allergy disease. Allergy trace cards have been used to identify the level of allergic risk, based on family atopy scores. Because environmental factors may also influence the development of atopic dermatitis, the usefulness of the allergy trace card needs to be reevaluated. Objective To compare the incidence of atopic dermatitis in infants aged 0-4 months with total family atopy scores of > 0 to those with scores of 0. Methods We conducted this cohort study from June 1, 2012 to December 31, 2012 at Sanglah Hospital, Denpasar. Family atopy score was tabulated from all pregnant woman in the Obstetric Outpatient Clinic and the Maternity Room. Subjects were divided into two groups based on their total family atopy score: those with scores > 0 and those with scores of 0. The appearance of atopic dermatitis symptoms in the infants were evaluated until they reached 4 months of age. The incidence of atopic dermatitis in two groups was compared using Chi-square test. Results The incidence of atopic dermatitis in this study was 10.9%. The group with total family atopy scores of 0 had a significantly higher incidence of atopic dermatitis than the group with scores > 0 (adjusted RR 22.5; 95%CI 8.8 to 57.0; P = 0.001). Conclusion The incidence of atopic dermatitis is higher in infants with total family atopy score > 0 and this group has a 22.5 times higher risk of atopic dermatitis compared to infants with total family atopy score of 0. Allergy trace cards are relevant in differentiating the risk of atopy with regards to development of atopic dermatitis. We suggest that family atopy scores be evaluated during antenatal care in order to limit the development of atopic dermatitis in infants

Tinggi Badan dan Usia Tulang Sindrom Nefrotik yang Mendapat Terapi Steroid Jangka Panjang

Pasien SN anak akan sering mendapat steroid yang memiliki efek samping seperti obesitas, penekanan pertumbuhan, hipertensi serta osteoporosis Tujuan Penelitian untuk menilai tinggi badan dan usia tulang pasien sindrom nefrotik yang mendapat terapi steroid jangka panjang dan mengetahui hubungannya dengan dosis kumulatif, lama terapi dan jumlah frekuensi. Retrospektif, deskriptif analitik, dengan subjek pasien sindrom nefrotik yang dirawat di Laboratorium Ilmu Kesehatan Anak RSUP Denpasar antara 1 Januari 1998 hingga 31 Juli 2000. Data diambil dari rekam medik sedangkan penentuan tinggi badan dan usia tulang dilakukan saat penelitian. Analisis regresi linier dilakukan untuk melihat hubungan antara tinggi badan dan usia tulang dengan dosis kumulatif, lama terapi, serta jumlah relaps. Kemaknaan ditentukan dengan p<0.05. Terdapat 16 pasien, dengan usia 7,3 tahun (+3,3), rerata dosis kumulatif steroid 4,1 mg (+2730), lama terapi 9,6 bulan (+2,4), rerata tinggi badan terhadap standar 97% (+4,8), D usia tulang + 8,3 bulan (+9,7). Tinggi badan tidak mempunyai hubungan dengan dosis steroid kumulatif, lama terapi maupun jumlah relaps (r=0.16, p>0.05). Usia tulang tidak mempunyai hubungan, baik dengan dosis steroid kumulatif, lama terapi, maupun jumlah relaps (r=0.39, p>0.05). Tinggi badan dan usia tulang pasien sindrom nefrotik pada penelitian ini tidak mempunyai hubungan dengan dosis kumulatif dan lama terapi steroid, maupun jumlah relaps

Level of knowledge on HIV I AIDS among senior high school students

Background Young people are now the epicenter and bear a disproportionate burden ofHIV/AIDS pandemic. Until now, one of the strategies which are implemented by the govern- ment is by increasing the level of HIV/AIDS knowledge in order to avoid its spreading. Objective This study was to explore the level of HIV/AIDS knowledge of senior high school's students towards HIV I AIDS at subdistrict ofPetang. The secondary outcome is to compare the levels of knowledge toward HIV I AIDS between Petang and Pelaga Senior high school, between class and gender. Methods This was a descriptive study, conducted between 1st to 28th February 2007 in Petang and Pelaga Senior High School. The study subjects are 529 students (all of senior high school students in subdistrict of Petang, Badung Regency). Data was taken using UNICEF questionnaire 2000 for young people, which had been passed the reliability test with the kappa value of 0.85. Results Most subjects (90.5%) have excellent and good knowledge and only 9,5% have sufficient knowledge. Level of knowledge in girls is better than boys with significant differ- ence between them (P=O.OOO), while school and grade didn't show any differences (P=0.760) and (P=0.489). Conclusion The level of knowledge of senior High School in Subdistrict ofPetang, Badung Regency toward HIV /AIDS is at excellent or good leve