The Effectiveness of Cardiopulmonary Resuscitation Training Using Feedback System on Chest Compression: A Comparative Study Between Doctor and Nurse

High-quality chest compression, adequate depth and rate, and minimal interruption are needed to improve the survival rate of cardiopulmonary resuscitation (CPR). Currently, CPR training with feedback system is considered to give high-quality CPR. Although doctor and nurse have a different educational background, both professions require proficiency in delivering CPR. This study aimed to compare the effectiveness of CPR training with a feedback system to the quality, depth, and rate of chest compression between doctors and nurses. This study was a cross-sectional study that involved 16 doctors and 19 nurses in CPR training with CPR feedback system. The quality, depth, and rate of chest compression performing by a group of doctors and a group of nurses were analyzed before and after CPR training. Data were collected and analyzed statistically. The results show that in the nurse group, there was a significant difference in quality, depth, and rate of compression before and after the training (p=0.000, p=0.000, p=0.000). In the doctor group, there was a significant difference of depth and quality of chest compression before and after the training (p=0.010, p=0.001). When comparing doctor and nurse group after training, no significant differences were observed in doing CPR (p=0.310, p=0.288, p=0.440)

Faktor Risiko Obstructive Sleep Apnea pada Anak Sindrom Down​

Latar belakang. Sindrom Down merupakan kelainan kromosom tersering. Anak dengan sindrom Down (SD) di berbagai negara memiliki beberapa faktor risiko terhadap OSA dengan prevalensii antara 30%-60%, dibandingkan 0,7%-2% pada populasi umum. Hingga saat ini belum ada data mengenai OSA pada anak sindrom Down di Indonesia. Tujuan. Mengidentifikasi prevalensi OSA pada anak sindrom Down dan menganalisis hubungan antara habitual snoring, obesitas, penyakit alergi di saluran napas, hipertrofi tonsil, dan hipertrofi adenoid sebagai faktor risiko OSA pada anak sindrom Down. Metode. Penelitian potong lintang dilakukan pada anak sindrom Down berusia 3-18 tahun yang tergabung dalam Yayasan POTADS. Penelitian dilakukan di Poliklinik Respirologi IKA FKUI RSCM dari bulan Juli 2016 hingga Juli 2017. Penegakan diagnosis OSA menggunakan nilai batas AHI≥3 pada pemeriksaan poligrafi. Faktor- risiko yang dianggap berpengaruh dianalisis secara multivariat. Hasil. Penelitian dilakukan terhadap 42 subjek dengan hasil prevalensi OSA pada anak dengan SD 61,9%. Sebesar 42,9% merupakan OSA derajat ringan, 14,3% OSA sedang, dan 4,8% OSA berat. Pada analisis multivariat didapatkan faktor risiko yang bermakna yaitu habitual snoring (p=0,022 dan PR 8,85; IK 1,37-57) dan hipertrofi adenoid (p=0,006 dan PR 12,93; IK 2,09-79). Kesimpulan. Prevalensi OSA pada anak sindrom Down sebesar 61,9%. Faktor risiko yang bermakna yaitu habitual snoring dan hipertrofi adenoid

A biregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa

To better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts

Transition practice for primary immunodeficiency diseases in Southeast Asia: a regional survey

IntroductionWith increased diagnostic capabilities and treatment modalities in the field of primary immunodeficiencies (PID), many pediatric patients survive beyond childhood and experience a change of care to the adult-oriented healthcare system. Unfortunately, the transition pathways for PID are less clearly defined, resulting in deterioration of quality of care in adulthood. Hence, this is the first regional study to address PID clinicians’ opinions on practices and challenges of transition care in 7 Southeast Asia (SEA) countries.MethodsWe adopted a cross-sectional study design through an online survey platform to enquire opinions of transition practices from expert representatives in 7 SEA countries.ResultsRegionally, 3 out 7 countries reported having no practice of transition care. Among cited challenges were reluctant adaptation by patients and caregivers to unfamiliarized adult healthcare systems, inadequate ratio of adult immunologists to patients and lack of facilities for transfer.Discussion and conclusionOur study provides evidence to advocate policy makers on the importance of standardized integration of transition practice towards betterment of transiting PID patients into adulthood

Targeted gene sanger sequencing should remain the first-tier genetic test for children suspected to have the five common X-linked inborn errors of immunity

DATA AVAILABILITY STATEMENT : The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author.To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing (SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa. With the increased use of Next Generation Sequencing (NGS), we have shifted our diagnostic practice from SS to WES. However, SS was still one of the key diagnostic tools for IEI for the past two decades. Our centre has performed 2,024 IEI SS genetic tests, with in-house protocol designed specifically for 84 genes, in 1,376 patients with 744 identified to have disease-causing mutations (54.1%). The high diagnostic rate after just one round of targeted gene SS for each of the 5 common IEI (X-linked agammaglobulinemia (XLA) 77.4%, Wiskott–Aldrich syndrome (WAS) 69.2%, X-linked chronic granulomatous disease (XCGD) 59.5%, X-linked severe combined immunodeficiency (XSCID) 51.1%, and X-linked hyper-IgM syndrome (HIGM1) 58.1%) demonstrated targeted gene SS should remain the first-tier genetic test for the 5 common X-linked IEI.The Hong Kong Society for Relief of Disabled Children and Jeffrey Modell Foundation.http://www.frontiersin.org/Immunologyam2023Paediatrics and Child Healt

Soy protein sensitization in cow’s milk allergy patients

Background The management of cow’s milk allergy (CMA) is avoidance of cow’s milk as strictly as possible. Extensive hydrolyzed protein and amino acid based formulas are recommended dietary products for treatment of CMA. However, they have some disadvantages, such as bitter taste and high cost. Alternative protein sources from vegetable proteins, such as soy, can be used as milk-substitute. Previous studies showed the prevalence of soy allergy in CMA patients in Western countries ranged between 0 to 63%, but the prevalence in Asia was not greater than 20% and no data about this prevalence in Indonesia. Objectives To determine the proportion of soy protein sensitization in CMA patients and characteristics of CMA patients who were sensitized to soy protein. Methods Fifty seven CMA patients who consumed soy protein were taken their blood sample to examine the soy-specific IgE. Results From 57 CMA patients, we found only 18% of patients who were sensitized to soy protein. Seven out of ten CMA patients who were sensitized to soy protein were under 12 months old. Atopic dermatitis was the most frequent clinical manifestation (8/10) and all of them had family history of atopic diseases. Soy sensitization in IgE-mediated and non-IgE mediated CMA were 6/10 and 4/10, respectively. Conclusions Proportion of soy sensitization in CMA patients in this study was 18%. Soy protein can be used as an alternative for cow’s milk substitute in CMA patients

Outcomes of prevention of HIV mother-to-child transmission in Cipto Mangunkusumo Hospital

Background Human immunodeficiency virus (HIV) infection is increasing worldwide. One foute of HIV transmission is from mother to child, during pregnancy, delivery or breastfeeding. Prevention of mothertochild transmission may be an effective strategy to reduce the cases of new HIV infections. Objectives To investigate the incidence of HIV infection in infants born to mothers with HIV and who received prophylactic therapy at birth, as well as to note the outcomes of HIVinfected children in this program. Methods This retrospective study was carried out over a 9year period, from January 20 03 to December 2011. The participants were HIVexposed infants who attended the HIV clinic, at the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta. Infants were treated according to the prevention of mothertochild transmission (PMTCT) protocol at CMH. Parents' and infants' data was recorded. The end point of this study was recording of HIVinfection status in the infants. Results There were 238 infants included in this study. HIV infection was confirmed in 6 (2.5%) infants, while 170 (71.4%) subjects were uninfected, and 62 (26.1%) subjects were lost to followup. No subjects who underwent complete PMTCT management were infected. Most subjects were male, fulltenn, and delivered by caesarean section in our hospital. The most frequently observed parental risk factor was intravenous drug use. Maternal antiretroviral therapy (ART) was given during pregnancy in most cases. Morbidities in all subjects were low. Conclusion The PMTCT program at CMH was effective for reducing the number ofHIVinfected infants from mothers with HIY. [Paediatrlndanes. 2012;52:294-9]

Terapi Antiretroviral Lini Kedua pada HIV Anak di RS. Cipto Mangunkusumo

Latar belakang. Akses terhadap terapi antiretroviral (ARV) semakin mudah saat ini dan membuat angka harapan hidup anak terinfeksi HIV semakin panjang. Dalam penanganan jangka panjang anak terinfeksi HIV, salah satu masalah baru yang timbul adalah gagal terapi dan resistensi obat. Tujuan. Menilai karakteristik pasien anak terinfeksi di RS. Cipto Mangunkusumo yang menggunakan terapi ARV lini kedua dan indikasi penggantian ke terapi ARV lini kedua. Metode. Penelitian kohort pasien anak terinfeksi HIV di RS Cipto Mangunkusumo sejak tahun 2002. Kriteria inklusi adalah pasien anak terinfeksi HIV yang berobat di RS Cipto Mangunkusumo sejak tahun 2002 sampai April 2012 dan menggunakan salah satu obat antiretroviral lini kedua. Data yang diambil adalah data demografis, kada CD4, jumlah virus, stadium klinis, dan kombinasi terapi ARV. Hasil. Empatratus empat pasien anak terinfeksi HIV dan 44 (10,9%) menggunakan terapi antiretroviral lini kedua. Sebagian besar (59,1%) gagal terapi adalah kombinasi antara kegagalan virologi, imunologis, dan klinis. Median usia saat memulai terapi ARV lini kedua 69 (26-177) bulan. Median lama subyek menggunakan terapi ARV lini pertama 9 (13-176) bulan. Seluruh subyek penelitian menggunakan lopinavir/ ritonavir sebagai salah satu obat ARV lini kedua dengan kombinasi terbanyak adalah didanosin, lamivudin, dan lopinavir/ritonavir (40,9%). Efek samping didapatkan pada 2 pasien akibat abacavir. Sebagian besar subyek (19/25) yang diperiksa jumlah virus pada 6-12 sesudah menggunakan ARV lini kedua mempunyai hasil tidak terdeteksi. Kesimpulan. Jumlah pasien yang menggunakan terapi ARV lini kedua tidak terlalu banyak karena deteksi kegagalan terapi masih lebih banyak berdasarkan kegagalan klinis dan imunologis

Thalassemia Alfa Mayor dengan Mutasi Non-Delesi Heterozigot Ganda

Seorang anak perempuan berusia 3 tahun dengan gejala klinis anemia berat, hepatosplenomegali, dan memerlukan tranfusi darah teratur. Gejala klinis telah timbul saat pasien berusia 3 bulan. Hapusan darah tepi menunjukkan gambaran hipokrom, mikrositosis, dan anisopoikilositosis. Kadar HbA2 normal, HbF sedikit meningkat, dan terdapat HbBart’s. Ayah dan ibu memiliki gambaran hematologis yang mendekati normal. Analisis DNA menunjukkan dua mutasi non-delesi (mutasi titik) pada gen globin a2 yaitu pada kodon 59 (GGCglisin→GACaspartat) dan IVS2-nt142 (AG→AA). Kasus ini adalah kasus pertama yang ditemukan di Departemen Ilmu Kesehatan Anak RS. Dr. Cipto Mangunkusumo Jakarta yang mempunyai mutasi heterozigot ganda pada kodon 59 dan IVS2-nt142. Gejala klinis thalassemia mayor diakibatkan adanya mutasi kodon 59 yang menghasilkan varian hemoglobin yang tidak stabil (HbAdana) disertai adanya mutasi non-delesi pada IVS2-nt142 yang menyebabkan proses mRNA yang tidak normal