Aspartat Amino Transferase-Platelet Ratio Index (APRI), Kadar Bilirubin dan Venektasi Penderita Kolestasis Anak di RSUP Dr. Kariadi Semarang

Aspartat amino transferase (AST)-platelet ratio index (APRI), bilirubin level and venectation of the pediatric cholestatic patient in Kariadi Hospital SemarangBackground: Cholestasis occurs when there is obstruction in the secretion of various substances, causing substances retention in the liver and cause damage to liver cells. The number of patients with cholestasis in infants and children is increasing, but diagnosis is still problematic. The purpose of this study is to describe cholestatic patients in Dr. Kariadi Hospital Semarang and to define correlation between APRI, bilirubin level, and venectation.Method: A retrospective study was conducted in Dr. Kariadi Hospital, Semarang from December 2010 until January 2012. Discriptive analysis was used to analyse data and Spearman Brown correlation was used to analyse correlation between APRI, bilirubin level, and venectation.Result: From December 2010 to January 2012 there were 29 patients with cholestasis. For 10 patient (34%) the cause of cholestatic problem could not be found. From 19 patient that were diagnosed, the most common cause of cholestasis in this group is cytomegalovirus (CMV) infection, followed by billiary atresia and cholelithiasis. In this study the AST-Platelet Ratio Index (APRI) of the subjects were between 0.26 and 11.09, with mean of 3.23. There was no correlation between the degree of liver fibrosis as measured using the APRI with high levels of bilirubin (r=0.36; p=0.58) and venectation in the subject (r=0.47; p=0.14).Conclusion: Patients with cholestasis in Dr. Kariadi Hospital were mostly under 2 years old and the most common cause are CMV infection. There was no correlation between the degree of liver fibrosis with bilirubin, which is one of parameter in determining the prognosis of patients with end stage liver disease, and venectation. Although APRI is sensitive to detect liver fibrosis but it is not sensitive to determine the degree of liver damage

Management of Obstructive Sleep Apnea Syndrome in Obese Children

Background : Obstructive Sleep Apnea Syndrome (OSAS) is strongly associated with obesity. The common presenting complaints are excessive daytime sleepiness and loud snoring which potential for significant comorbidity of metabolic syndrome and decreasing in quality of life. Case : An 11-year-old obese boy was refereed to Dr. Kariadi Hospital with complaints of fatique and frontal headache. His mother reported the loud snoring, apneic events during the night, excessive daytime sleepiness, increased irritability, and difficulty of school learning. Imaging studies showed cardiomegaly, adenoidal/nasopharyngeal ratio 0.714; opaque mass on cervical and airway space narrowing. Tympanometric audiogram showed mild right conductive hearing loss. The patient was diagnosed with OSAS, chronic and hypertrophic adenotonsillitis, severe hypertension, dilated right ventricle, right conductive hearing loss, obesity. The boy was undergone adenotonsillectomy and management of weight lossed. Antihipertensive and other supportive medication were given and good results. Discussion : The recommended initial treatment, even in obese children, consists of surgical removal of the adenoids and tonsils.5,6 Several studies have shown that adenotonsillectomy reverses the symptoms and confirm the beneficial effects for OSAS on children's growth, school performance, improvements in PSG, behavior, QoL and cardiac function. The success rate for adenotonsillectomy in the context of OSA was approximately 85%. Conclusion : Adenotonsillectomy and weight reduction is considered to be the primary intervention for OSAS children. Because the case had also severe hypertension, antihypertensive and other supportive medicine were give and had a good result. Keywords : OSAS, obesity, children, adenotonsillectomy &nbsp