Precocious puberty in McCune-Albright syndrome: a case report

McCune-Albright syndrome (MAS) is a rare disease characterized by a triad of fibrousdysplasia, cafe-au-lait spots and peripheral precocious puberty. We reported a 5-year-8-month old girl with MAS who has been followed-up for 2 years and 8 months. Shewas referred to pediatric endocrinology clinic in our hospital for vaginal bleeding at ageof 2 years 11 months. She had peripheral precocious puberty, i.e. increased estrogenlevel associated with very low gonadotropins, and cafe-au-lait spots on her face and wasdiagnosed as MAS. The patient was treated with estrogen receptor blocker (tamoxifen).She had no menses during the 2 years and 8 months of tamoxifen treatment. Her growthrate and bone maturation were also in normal ranges. However, at the end of tamoxifentreatment she had an episode of vaginal bleeding so that we had to change to othertreatment modalities

An increase in mean platelet volume (MPV) as a predictor of mortality in children with sepsis

Sepsis is associated with increased morbidity and mortality in children worldwide, mainly in developing countries. This fatal risk emphasizes the importance of finding accessible and inexpensive parameters to be used as predictors for mortality in children with sepsis. The aim of this study was to determine the role of increased mean platelet volume (MPV) as a predictor for mortality in children with sepsis.  A case control study was applied using medical records of all in-patients aged 1 mo -18 y diagnosed with sepsis at Dr. Sardjito General Hospital, Yogyakarta from January 2015-December 2016. Bivariate and multivariate analyses by Chi-square and logistic regression to evaluate the correlations between increased MPV within the first 24-72 h (ΔMPV>0) and mortality were applied. Eighty-one eligible subjects met the inclusion/exclusion criteria with the mortality was 52%. Chi-square analysis showed significant correlations between increased MPV and mortality (p=0.005). Multivariate analysis showed increased MPV within the first 24-72 h after sepsis diagnosis as a predictor for mortality after controlling for sex and AKI (adjusted OR 3.851; 95% CI:1.354-10.948; p= 0.011). In conclusion, an increase in MPV within the first 24-72 h after diagnosed is an independent predictor for mortality in children with sepsis

Profil Klinis Anak dengan Demam Tifoid di Rumah Sakit Umum Pusat Dr Sardjito Yogyakarta

Latar belakang. Demam tifoid masih merupakan masalah kesehatan masyarakat yang penting di Indonesia. Gambaran klinis tifoid sangat bervariasi, seperti gejala klinis ringan hingga berat yang disertai komplikasi. Tujuan. Untuk mengetahui gambaran manifestasi klinis, laboratorium, dan tata laksana DT anak yang dirawat di RSUP Dr. Sardjito. Metode. Penelitian retrospektif ini dilakukan menggunakan data rekam medis pasien DT anak yang menjalani rawat inap sejak Januari 2011 hingga Mei 2016. Hasil. Ditemukan 158 kasus DT yang terbukti secara serologis (96,8%), kultur darah (1,3%), maupun keduanya (1,9%). Demam merupakan gejala utama pada seluruh pasien. Gejala penyerta lain adalah anoreksia (54,4%), mual (49,4%), muntah (41,8%), nyeri kepala (37,3%), batuk (37,3%), nyeri perut (34,2%), konstipasi (30,4%), dan diare (29,7%). Tanda yang paling sering didapatkan adalah pembesaran hati (29,7%), nyeri tekan abdomen (20,3%), limfadenopati (13,3%), letargi (13,3%), lidah kotor (12,0%), pembesaran limpa (6,3%) dan penurunan kesadaran (4,4%). Rerata lama rawat inap adalah 8,4±6,2 hari, mortalitas 2,5% diakibatkan oleh sepsis berat. Respon pasien 81,0% terhadap pemberian antibiotik, terbanyak diresepkan adalah ceftriaxone (45,6%). Komplikasi berupa sepsis (10,1%), hepatitis (8,9%), perdarahan saluran cerna (5,7%), ensefalopati (4,4%), dan perforasi usus (0,6%). Kesimpulan. Profil klinis anak dengan DT serupa dengan gambaran umum pasien di daerah endemis. Penegakan diagnosis pasti dengan menggunakan kultur darah masih belum banyak membantu di rumah sakit kami. Mortalitas yang masih cukup tinggi perlu diteliti lebih lanjut untuk perbaikan prognosis pasie

A Chronicle of Indonesia’s Forest Management: A Long Step towards Environmental Sustainability and Community Welfare

Indonesia is the largest archipelagic country in the world, with 17,000 islands of varying sizes and elevations, from lowlands to very high mountains, stretching more than 5000 km eastward from Sabang in Aceh to Merauke in Papua. Although occupying only 1.3% of the world’s land area, Indonesia possesses the third-largest rainforest and the second-highest level of biodiversity, with very high species diversity and endemism. However, during the last two decades, Indonesia has been known as a country with a high level of deforestation, a producer of smoke from burning forests and land, and a producer of carbon emissions. The aim of this paper is to review the environmental history and the long process of Indonesian forest management towards achieving environmental sustainability and community welfare. To do this, we analyze the milestones of Indonesian forest management history, present and future challenges, and provide strategic recommendations toward a viable Sustainable Forest Management (SFM) system. Our review showed that the history of forestry management in Indonesia has evolved through a long process, especially related to contestation over the control of natural resources and supporting policies and regulations. During the process, many efforts have been applied to reduce the deforestation rate, such as a moratorium on permitting primary natural forest and peat land, land rehabilitation and soil conservation, environmental protection, and other significant regulations. Therefore, these efforts should be maintained and improved continuously in the future due to their significant positive impacts on a variety of forest areas toward the achievement of viable SFM. Finally, we conclude that the Indonesian government has struggled to formulate sustainable forest management policies that balance economic, ecological, and social needs, among others, through developing and implementing social forestry instruments, developing and implementing human resource capacity, increasing community literacy, strengthening forest governance by eliminating ambiguity and overlapping regulations, simplification of bureaucracy, revitalization of traditional wisdom, and fair law enforcement