Effects of Duration of Breastfeeding During Infancy on Vascular Dysfunction in Adolescents

Aim: to investigate the effect of breastfeeding duration on vascular characteristics in adolescence. Methods: we conducted a retrospective cohort study on adolescents aged 15-18 years old. Breastfeeding duration was inquired using a questionnaire filled by parents and categorized into 0-12 months. Outcomes assessed were flow mediated dilation (FMD), carotid intima media thickness (CIMT), anthropometrics. Analysis was done using linear regression and MANOVA general linear model with cardiovascular risk factors as the dependent variables and breastfeeding duration as the independent variable with further adjustment for confounders. Results: 285 subjects aged 15-18 years were enrolled. Breastfeeding duration of 4-<6 months was associated with thinner CIMT and the effect was more prominent after adjustment for gender and postnatal tobacco exposure (mean difference=24.28 micrometer, p=0.045). No statistically significant association was found with FMD. Conclusion: breastfeeding duration of 4-<6 months is associated with thinner IMT and thus has a protective effect on the development of cardiovascular disease. However the association with FMD in adolescence is less clear.Key words: breastfeeding duration, vascular structure and function, cardiovascular risk

ICAM-1 and S100β plasma value in children with sepsis

ICAM-1 release during sepsis is perceived to be related to brain injury. Whereas S100β  has been known as one of brain injury markers.To measure mean value of ICAM-1, S100β, to find correlation between ICAM-1 and Glasgow Coma Scale (GCS), between S100β and GCS, also ICAM-1 and S100β.Analytical cross sectional study in 34 sepsis children, measurement of ICAM-1 and S100β plasma levels within day 1 and 3 since diagnosis of sepsis.Median level of  ICAM-1 day one 548,1 (158,6 – 1256,1) ng/mL and day three 596,5 (185,5 – 1264,5) ng/mL (p=0,164). S100β median is significantly higher in severe than mild sepsis (p=0,008 dan p=0,021). On third day S100β was negatively related to GCS (r= - 0,452; p=0,003). The correlation observed between ICAM-1 and S100β on day one was r=0,146 (p=0,409) while on third day was r=0,184 (p=0,298).The prevalence of encephalopathy sepsis is 5.9%, Median ICAM-1 is higher on day three. Median of S100β is higher in severe than mild sepsis.There is no correlation between ICAM-1 and GCS in both sepsis. There was negative correlation between S100β  and GCS  on 3rd day of sepsis. No correlation between ICAM-1 and S100β  on both measurement days

Transcatheter Closure of Patent Ductus Arteriosus in Adolescents and Adults: A Case Series

During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients  who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety

Massa Dan Fungsi Ventrikel Kiri Pada Malnutrisi Energi Protein Tipe Marasmus

Objectives. To determine the left ventricular mass, the left ventricular systolic anddiastolic function of children suffering protein energy malnutrion marasmic type. Material.Pediatric patients suffering protein energy malnutrion marasmic type who came for treatment in Division of Pediatric Metabolic Nutrition, Departement of Child Health, Medical Faculty, Cipto Mangunkusumo Hospital Jakarta between June to August 2007.Methods. A cross-sectional study was conducted to evaluate left ventricular systolic function (EF and FS), left ventricular diastolic function (E, A, ratio E/A and IVRT) and left ventricular mass (LVDDi, LVDSi, LVMi) by Ultrasonography Sonos 4500. The student t-test was used, statistical significant was assumed with a&lt; 0.05 with program SPSS 15.0 version. Results. Out of 25 subjects examined (9 male and 16 female), the left ventricular mass in marasmic patients was lower compared to control. Mean of LVMi (g/m2) marasmic and control each 22.5 (SD 17.7) and 39.1 (SD 41.1); p &lt; 0.02. Systolic and diastolic function in marasmic were lower than the control and the difference was statistically significant. Mean EF in marasmic and control each 56.4% (SD 7.2) and 73.2% (SD 7,7) ; p = 0.001. Mean FS 28.6% (SD 4,9) and 40.4% (SD 8.7) ; p = 0.001. Mean ratio E/A in marasmic and control each 1.79 (SD 0.5) and 1.54 (SD 0.2); p = 0.04Conclusions. The left ventricular mass in marasmic was lower than a child with good nutrition. The left ventricular systolic and diastolic function of marasmic patients were disturbed. The left ventricular diastolic function seen in restrictive pattern.Tujuan. Menilai massa, fungsi sistolik dan fungsi diastolik ventrikel kiri padaanak yang menderitamalnutrisi energi protein (MEP) tipe marasmus. Tempat penelitian. Divisi Kardiologi dan Divisi Gizi Metabolik Anak FK UI/RSCM Jakarta.Subyek penelitian. Penderita malnutrisi energi protein (MEP) tipe marasmus yang dirawat atau yang datang berobat ke Divisi Gizi Metabolik Anak FKUI-RSCM sejak bulan Juni– Agustus 2007. Metode. Dilakukan penelitian observasional dengan rancang bangun cross sectional. Data meliputi fungsi sistolik ventrikel kiri (EF dan FS), fungsi diastolik ventrikel kiri (E, A, rasio E/A, IVRT) danmassa ventrikel kiri ( LVDDi, LVDSi, LVMi) dengan menggunakan mesin ultrasonografi Sonos 4500, transduser 8 MHz. Data diolah dengan SPSS versi 15. Dilakukan uji t. Nilai yang dipakai adalah 0,05. Jumlah subyek minimal yang diperlukan adalah 25.Hasil. Dari 25 subyek marasmus yang diperiksa (9 laki – laki dan 16 perempuan). Massa ventrikel kiri marasmus lebih rendah dibanding kontrol. Rerata LVMi (g/m2) marasmus dan kontrol masing-masing 22,5 (SB 17,7) dan 39,1 (SB 41,1); p&lt; 0,02. Fungsi sistolik dan diastolik marasmus lebih rendah dibanding kontrol dan perbedaan ini secara statistik bermakna. Rerata EF marasmus dan kontrol masing-masing adalah 56,4% (SB 7,2) dan 73,2% (SB 7,7) ; p = 0,001. Rerata FS 28,6% (SB 4,9) dan 40,4% (SB 8,7) ; p = 0,001. Rerata rasio E/A marasmus dan kontrol masing-masing 1,79 (SB 0,5) dan 1,54 (SB 0,2); p = 0,04. Kesimpulan. Massa ventrikel kiri pasien marasmus lebih rendah dari pada anak gizi baik,Fungsi sistolik dan fungsi diastolik pasien marasmus telah mengalami gangguan. Fungsi diastolik ventrikel kiri memperlihatkan pola restriktif

Menyongsong Masyarakat Ekonomi ASEAN 2015: Apakah Dokter Indonesia Sudah Siap?

No Abstrac

Prevalence of patent ductus arteriosus in premature infants at the Neonatal Ward, Cipto Mangunkusumo Hospital, Jakarta

Background Patent ductus arterious (PDA) is one of the most common congenital heart diseases encountered in preterm infants. The lower the birth weight and gestational age are, the higher the incidence of PDA is. Objectives To investigate the incidence of PDA in premature infants hospitalized in the neonatal wards of Cipto Mangunkusumo Hospital using echocardiography. Methods Preterm infants born between August and October 2003 were included in this study. Clinical features were retrieved from medical charts. The first echocardiography was conducted on all of the preterm infants at the chronological age of 3 days. If PDA was detected, echocardiography was repeated at the chronological age of 6 days. Results During the 3-month period, sixty-five preterm infants participated in this study and underwent echocardiography. In the first echocardiogram, the incidence rate of PDA was 32%. At gestational age of less than 28 weeks, 1 of 2 infants had PDA. Of 3 infants with birth weight of more than 1000 grams, 2 had PDA. On the second echocardiography, the incidence rate of PDA was 14% and mostly found in infants at gestational age of less than 28 weeks (8/9) and in those with birth weight of less than 1000 grams (7/9). All infants with RDS whose PDA was identified in the first echocardiography proved to maintain their PDA in the second echocardiography. Conclusion The incidence rate of PDA in preterm infants was 14%. The lower the birth weight, the higher the incidence rate of PDA. The presence of RDS is related to the delay in the closing of the arterial duc

Akurasi Pulse Oksimetri Fingertip Dibandingkan Pulse Oksimetri Generasi Baru dalam Deteksi Dini Penyakit Jantung Bawaan Kritis pada Bayi baru Lahir: Penelitian Pendahuluan

Latar belakang. Peningkatan morbiditas dan mortalitas bayi baru lahir dengan penyakit jantung bawaan kritis berkaitan dengan diagnosis yang terlambat. Tujuan. Mengetahui nilai diagnostik pulse oksimetri fingertip dibandingkan generasi baru untuk deteksi dini PJB kritis pada bayi baru lahir. Metode. Penelitian dilakukan di Ruang Rawat Gabung RSCM pada bayi bugar, usia gestasi 37 minggu, dan berusia 24-72 jam. Oksimetri dilakukan di tangan kanan (preduktal) dan kaki (postduktal). Subjek dengan SpO2 3% antara tangan kanan dan kaki diperiksa lebih lanjut. Hasil. Pada 442 bayi, SpO2 preduktal kedua jenis pulse oksimetri bervariasi secara statistik namun tidak bermakna klinis. Tidak ada subjek dengan hasil deteksi positif dan didiagnosis PJB kritis melalui pemeriksaan oksimetri. Kesimpulan. Uji diagnostik pulse oksimetri fingertip dibandingkan generasi baru untuk deteksi dini PJB kritis pada bayi baru lahir pada penelitian ini belum dapat dinilai

The role of physical activity on cardiovascular risk factors in adolescents

Background Cardiovascular diseases remain the leading cause of death worldwide. Atherosclerotic process increases rapidly during adolescence. Physical activity is considered important in this period to modify cardiovascular risk factors, thus preventing disease in the future. Objective To determine whether different physical activity status in adolescence can influence body mass index (BMBMI), waist-to-hip ratio, blood pressure (BP), and blood lipid profile. Methods This was a cross-sectional descriptive study, conducted from December 2009 to January 2010. Adolescents who fulfilled the study criteria were classified into high and low physical activity category. Further examination including body mass index, waist-to-hip ratio, blood pressure, and blood lipid profile were performed. Results Adolescents with high physical activity had higher, but statistically insignificant, BMBMI compared to adolescents in the P=0.493] and significantly lower waist-to-hip ratio [0.80 (range 0.73-0.9) vs.. 0.82 (range 0.7-0.9), P=0.019]. Difference in BP was not statistically significant between both groups [diastolic BP (70 (range 60-90) mmHg vs. 70 (range 60-90) mmHg, P=0.148; systolic BP 100 (range 90-130) mmHg vs. 100 (range 90-140) mmHg, P=0.228)]. Blood lipid examination in the high activity group showed significantly higher HDL cholesterol and lower triglyceride compared to the low activity group [HDL 59.8 (SD 11.8) mg/dL vs. 54.7 (SD 8.9) mg/dL; p=0.044; triglyceride: 60 (range 32-203) mmHg vs. 82 (range 37-198) mmHg, P=0.014]. Total and LDL cholesterol [total cholesterol 169.8 (SD 28.6) mmHg vs. 181.2 (SD 30.8) mmHg, P=0.107; LDL 103.6 (SD 26.8) mmHg vs. 114.1 (SD 27.3) mmHg, P=0.100] were lower in the high activity group but not statistically different in both groups. Conclusions Adolescents with high physical activity show less cardiovascular risk factors compared to those in the low physical activity group

Assessment of health-related quality of life in children with cancer using PedsQL™ (a preliminary study)

Background Cancer in children can adversely affect their developments and growth. The assessment of health-related quality of life (HRQL) will justifY its physical and psychological effects. Methods Seventy-seven subjects who underwent therapy were assessed using the PedsQL™, which consisted of parent-proxy reports and or child-self reports. PedsQL™ is assessments of physical, social, emotional and role functions. The control group was students with the same number and age as the sample group. Results Children with cancer had lower HRQL than normal healthy children (odds ratio 3. 7). Children with cancer who came from low socio-economic families had lower social functions and girls had tendencies to have lower quality oflife. Fathers' education had strong influence in children's quality of life. Leukemic patients had better quality of life than those of lymphoma and solid organ tumor. Group with age of diagnosis at 6-9 year old had lower HRQL compared with younger or older groups. The longer period of illness was, the more emotional function would improved. Despite of a good accordance between parents' and child's reports, parents usually had reports about having lower quality of life. Conclusions Children's HRQL is influenced by clinical characteristics and social-demographic variables differently. Assessment of the children's HRQL is better done with parents and or child as the source of information

Automated image segmentation for cardiac septal defects based on contour region with convolutional neural networks: A preliminary study

Echocardiogram examination is important for diagnosing cardiac septal defects. With the development of AI-based technology, an echocardiogram examination previously performed manually by cardiologists can be done automatically. Automatic segmentation of cardiac septal defects can help a physician to make an initial diagnosis before referring a pediatric cardiologist for further treatment. In previous studies, automatic object segmentation using convolutional neural networks (CNNs) was one of the DL applications that have been developed for cardiac abnormalities. In this study, we propose a CNN-based U-Net architecture to automatically segment the cardiac chamber to detect abnormalities (holes) in the heart septum. In this study, echocardiogram examinations were performed on atrial septal defects (ASDs), ventricular septal defects (VSDs), atrioventricular septal defects (AVSDs), and normal hearts with patients undergoing echocardiogram examination at Moh Hoesin Hospital in Palembang. The results show that even for the relatively small number of datasets, the proposed technique can produce superior performance in the detection of the cardiac septal defects. Using the proposed segmentation model for four classes produces a pixel accuracy of 99.15%, mean intersection over union (IoU) of 94.69%, mean accuracy of 97.73%, sensitivity of 96.02%, and F1 score of 94.88%, respectively. The plots of the loss and accuracy curve show that all the errors were small, with accuracy rates reaching 99.05%, 98.62%, 99.39%, and 98.97% for ASD, VSD, AVSD, and normal heart, respectively. The comparison accuracy of contour prediction for U-Net was 99.01%, while V-Net was 93.70%. This shows that the U-Net has better accuracy than the V-Net model architecture. It can be proven that the architecture of CNNs has been successful in segmenting the cardiac chamber to detect defects in the heart septum and support the work of cardiologists