Corticosteroids and obesity in steroid-sensitive and steroid-resistant nephrotic syndrome

Background Children with nephrotic syndrome need high-dose corticosteroids to achieve remission. Studies have estimated a 35-43% risk of obesity in these patients after corticosteroid treatment. Objective To determine the prevalence of obesity in children who received corticosteroids for nephrotic syndrome, and to compare the risk of obesity in children with steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS). Methods We performed a retrospective cohort study in 50 children with SSNS or SRNS who received corticosteroid treatment. Obesity was defined to be a BMI-for-age Z-score above +2.0 SD, according to the WHO Growth Reference 2007. Central obesity was defined to be a waist-to-height ratio > 0.50. Results The overall prevalence of obesity was 22%, with 29% and 14% in the SSNS and SRNS groups, respectively. The overall prevalence of central obesity was 50%, with 54% and 46% in the SSNS and SRNS groups, respectively. The cumulative steroid doses in this study were not significantly different between the SSNS and SRNS groups. There were also no significant differences between groups for risk of obesity (RR 2.53; 95%CI 0.58 to 10.99) or central obesity (RR 1.39; 95%CI 0.45 to 4.25). Conclusion In children with nephrotic syndrome who received corticosteroids, the prevalence of obesity is 22% and of central obesity is 50%. In a comparison of SSNS and SRNS groups, cumulative steroid dose as well as risks of obesity and central obesity do not significantly differ between groups

Prevalence of hypertension and its risk factors among obese adolescents in Yogyakarta, Indonesia

Obesity and overweight are considerable health problems with increasing prevalence among adolescents. In Indonesia, basic health research data from Riskesdas shows an increase in the prevalence of obesity in adolescents aged 13-15 y.o, from 2.6% in 2010 to 6.7% in 2013. This high prevalence of overweightand obesity is related to various factors. This study aimed to determine the factors associated with hypertension and obesity in adolescents. This study was conducted on an overweight population, obese, and super-obese adolescents aged 13-15 year in the Yogyakarta City, Indonesia. Demographic data included the history of breastfeeding, birth weight, gender, history of premature birth, lifestyle, and physical activity were gathered. Anthropometric data included the weight, height, and body mass index (BMI) were also measured and gathered. Hypertension was measured using a manual sphygmomanometer. The relationship was analyzed using Pearson chi-squareand the risk value was demonstrated from the odds ratio (OR). A significant relationship between gender and diastolic hypertension was observed (OR= 2.4; 95%CI = 1.23 – 5.09; p 0.05). in conclusion, there is a relationship between gender and diastolic hypertension incidence among obese adolescents. Boys are more at risk of obesity compared to girls

Hunter syndrome with hyperthyroidism: a 16 month follow-up reprt

Mucopolysaccharidosis (MPS) is a rare genetic disorder caused by a deficiency in the activity of lysosomal enzymes required for glycosaminoglycan (GAG) degradation. An accumulation of GAG in many organs results in progressive cellular damage, and clinically results in joint stiffness, airway and cardiac as well as, mental and hearing impairments. Incidence of MPS was reportedly 2.04 per 100,000 live births, but varies depending on type and region. In Taiwan, MPS type II was the most prevalent MPS, with an incidence of 1.07 per 100,000 live births.1 MPS is generally inherited in an autosomal recessive pattern, with the exception of MPS II, which is X-linked recessive.2 There are seven types of MPS (MPS I, II, III, IV, VI, VII, and IX), based on enzyme deficits.3 The types of MPS with their enzyme deficiencies are listed in Table 1. Mucopolysaccharidosis shows wide clinical heterogenity, and is, therefore, difficult to diagnose. Skeletal involvement in MPS include coarse face, loss of joint range of motion, restricted mobility, and slowed growth leading to short stature. Other signs and symptoms include vision and hearing loss, recurrent respiratory infections, obstructive sleep apnea, hepatosplenomegaly, umbilical and inguinal hernia, hydrocephalus, spinal cord compression, and cognitive impairment.2,4 Patients with suspected MPS should have urinary GAG laboratory testing and enzyme activity assays in tissue (blood or fibroblasts). Urinary elevation of GAG, as compared with GAG levels expected in age-matched normal subjects, is the first diagnostic approach. The definitive specific diagnosis for MPS is based on enzyme activity assays from cultured fibroblasts, leukocytes, plasma, or serum.2,5,6 The MPS patients require multidiciplinary subspeciality management, including ENT, orthopedics, cardiology, pulmonary, growth and development, and physiotherapy. Specific treatments for MPS are hematopoietic stem cell transplantation (HSCT) and enzyme-replacement therapy (ERT) with recombinant human enzymes for MPS I, II, and VI.3,6,7,8 Life expectancies in MPS may vary among types, but generally are markedly reduced. Patients with MPS III and VII and severe forms of MPS I and MPS II have mental retardation. Patients with MPS II usually survive until only the second decade of life, with respiratory failure as the leading cause of death (56%), followed by cardiac failure (18%).9,1

Asupan protein, kalsium dan fosfor pada anak stunting dan tidak stunting usia 24-59 bulan

Background: Indonesia is one of developing country which still facing a serious problem concerning stunting. Causes of stunting is a complex things, one of the cause is protein intake which is have effect on the level plasma insulin growth factor I (IGF-I), protein bone matrix and growth factor, also calcium and phosphorus that has an important role in bone formation. One of the province in Indonesia which has stunting prevalence above level of National prevalence is West Borneo. Pontianak as the capital city of West Borneo is still facing serious problem concerning stunting and the low level of food security.Objective: Analyze protein, calcium and phosphorus intake of stunting and non stunting children aged 24-49 months in Pontianak.Method: The study was an analytical observational with cross sectional design. Samples of the study were children aged 24-59 months in the districts of East Pontianak and North Pontianak, West Borneo, as much as 90 samples have been chosen by using simple random sampling technique. The research was conducted from July - August 2015. Statistical analysis was performed by using chi square and t-test.Results: Protein, calcium and phosphorus intake are lower to the stunting compare to non stunting children (p<0,05). Stunting prevalence of  lower protein group is higher 1,87 times than adequate protein intake group. Stunting prevalence of low calcium intake group is higher 3,625 times than adequate calcium intake group. Moreover, the stunting prevalence of low phosphor intake group is higher 2,29 times than adequate phosphor intake group.Conclusion: Protein, calcium and phosphor intake significant lower to the stunting compare to non stunting children aged 24- 59 months in Pontianak.

Faktor prediktor malnutrisi rumah sakit pada anak di RSUP Dr. Sardjito

Predictors of pediatric hospital acquired malnutrition in a Sardjito HospitalBackground: In hospitalized children, nutrition is essential for the healing process as well as for reaching adequate growth. Hospital-acquired malnutrition (HAM) is declining in children’s body weight during hospitalization. The impact of undetected HAM including an increase in length of stay, increase in mortality, slowing of healing process, and increasing in hospital bills.Objectives: This study aims to determine the predictive factors of HAM.Method: A prospective study was performed. Samples were 1-month-old – 18-years-old children who hospitalized in pediatric ward of Sardjito Hospital in Yogyakarta from February 2023 to April 2023. Samples were taken using a consecutive sampling method. The relationship between variables was presented as odds ratio (OR), confidence intervals of 95%, the score for each variable, and statistical significance levels p < 0.05.Results: 21 of 196 patients were diagnosed as HAM, with a male-to-female ratio of 1.1: 1. The prevalence of HAM was 10.9%. Bivariate analysis showed that maternal education (OR=2.27; CI 95% 1.02 – 5.05; p=0.041), comorbid of congenital heart disease (CHD) (RR=3.31; CI 95% 1.30 – 8.42; p=0,037), and 3rd degree of severity disease (RR=6.00; CI 95% 2.87 – 12.56; p=0.001) was significantly related to HAM. Multivariate analysis showed that comorbid of CHD (OR=5.33; CI 95% 1.34 – 20.7; p=0.017) and 3rd degree of severity disease (OR=11.54; CI 95% 3.52 – 37.86; p=0.000) increased the odds of developing of HAM.Conclusion: Comorbid of CHD and 3rd degree of severity disease increased the odds of developing HAM during hospitalization

Korelasi Derajat Obesitas dengan Prestasi Belajar Siswa Sekolah Dasar

Latar belakang. Kejadian obesitas saat ini meningkat di seluruh dunia. Semakin berat derajat obesitas, komorbid yang dialami oleh anak obesitas juga semakin banyak. Obesitas menimbulkan stigma pada masyarakat, bahwa anak obesitas adalah anak yang malas, jelek dan bodoh. Hubungan yang jelas antara obesitas dengan prestasi belajar anak di sekolah belum dapat dibuktikan. Tujuan. Mengetahui hubungan derajat obesitas pada siswa sekolah dasar (SD) dengan prestasi belajar di sekolah. Metode. Potong lintang analitik dan pemilihan sampel penelitian dilakukan dengan acak bertingkat. Penelitian dilakukan pada siswa sekolah dasar yang berusia 6-13 tahun di Denpasar, dari Januari 2011 sampai dengan Juni 2011. Hasil. Penelitian dilakukan pada 1305 siswa SD yang disurvei, didapatkan 211 (16,1%) anak menderita obesitas. Didapatkan 60% berjenis kelamin laki-laki dengan rentangan umur 7 sampai 12 tahun dan rentangan IQ 81 sampai dengan 119. Analisis regresi linier menunjukkan bahwa penurunan nilai rerata bahasa Indonesia 23% dan penurunan nilai rerata matematika 15% berhubungan dengan peningkatan persentase derajat obesitas. Kesimpulan. Derajat obesitas berhubungan dengan prestasi belajar siswa sekolah dasar. Derajat obesitas ditemukan berhubungan lebih kuat dengan penurunan nilai rerata bahasa Indonesia dibandingkan dengan matematika

Body mass index and waist-to-height ratio cut-offs as predictors of high blood pressure in adolescents

Background: Obesity is associated with increased risk for high blood pressure (BP). Although a routine BP measurement is indicated for all children visiting pediatric practice, recognition of children particularly at risk may save times. The aim of this study was to assess the cut-off point for body mass index (BMI) and waist-to-height ratio (WHtR) to predict high BP in adolescents. Methods: We conducted a cross-sectional study on 928 children aged 11 to 16 years in Yogyakarta. BP were measured using standard technique described by The Fourth Report on The Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. BMI was adjusted for age and sex using the WHO 2007 growth reference. WHtR was ratio of waist circumference related to height in centimeters. Receiver operating characteristic (ROC) curves were used to estimate the best cut-offs. Results: The best cut-off point for BMI-for-age Z-score (BMIZ) to predict high BP was 0.51 with sensitivity and specificity of 82% (95% CI = 78-86) and 76% (95% CI = 67-78) for systolic BP and sensitivity and specificity of 82% (95% CI = 78-86) and 72% (95% CI = 68-76) for diastolic BP. The best cut-off point for WHtR was 0.45, with sensitivity of 76% (95% CI = 67-78) and specificity of 74% (95% CI = 71-79) for systolic BP and sensitivity of 76% (95% CI = 72-80) and specificity of 70% (95% CI = 61-75) for diastolic BP.Conclusion: BMIZ of 0.51 and WHtR of 0.45 are the best cut-off point to predict high BP in adolescents.</p

Glycated hemoglobin HbA1c, waist circumference, and waist-to-height ratio in overweight and obese adolescents

Background Central obesity has been associated with a high risk of insulin resistance. Waist circumference and waist-to-height ratio are anthropometric indices for determining central obesity and have been associated with increased blood pressure, cholesterol, and insulin levels. In adults, fat distribution around the waist is a valid predictor of glycated hemoglobin (HbA1c)levels, and is currently recommended by experts as a diagnostic tool for diabetes. Central obesity measurement has advantages over fasting blood glucose and oral glucose tolerance tests, as it is simple and inexpensive to perform. Objective To assess for correlations between HbA1c level and waist circumference as well as waist-to-height ratio and to assess factors potentially associated with HbA1c levels in overweight and obese adolescents. Methods This cross-sectional study was done in four junior high schools in Yogyakarta, which were obtained by cluster sampling. Overweight and obese students who were generally healthy were included in the study. Subjects underwent waist circumference and waist-to-height ratio measurements, as well as blood tests for HbA1clevels. Results Sixty-seven children participated in the study, with 48 girls (71.6%) and 19 boys (28.4%). Waist circumference and HbA1c levels were not significantly associated (r=0.178; P=0.15). However, waist-to-height ratio and HbA1c levels had a weak positive correlation (r=0.21; P=0.04). Linear regression analysis revealed that waist-to-height ratio had a significant association with HbA1c level (P=0.02), but age, sex, and nutritional status did not. Conclusion Waist-to-height ratio is correlated with HbA1c levels in overweight and obese adolescents