Penanganan Demam Reumatik Pada Anak

ABSTRAK Rheumatic fever is an inflammatory syndrome which some times follows beta haemolytic group A Streptococcal infections of the throat, and characteristically tends to recur. The incidence of rheumatic fever has fallen sharply in economically developed countries, although among the majority of the world\u27s population, rheumatic heart disease remains the most common cardiovascular cause of death. The recent resurgence of rheumatic fever in middle-class families in some part of the economically developed world has re-emphasized the fact that higher standard of living and avaibility of primary health care, are not the complete answer to the decrease in rheumatic fever. The association between group A beta haemolytic streptococcal upper respiratory tract infection and the subsequent development of acute rheumatic fever is well established. Rheumatic fever may affect a number of organs and tissues, singly or in combination of them, therefore the diagnosis is based on appropriate combination of them. The appropriate combination has been formulated in Jones criteria. Management of the diseases should be started with bed rest for 2 to 6 weeks, depending on the nature and severity of the attack. All patiens should be given antibiotic. Anti inflamatory treatment is given only to patients with arthritis and/or carditis. Secondary prophylaxis should be performed in preventing the subsequent development of recurrent attacks of rheumatic fever. Immunoprophylaxis due to the discovery of epitopes or immimodeterminant parts of M-protein molecule looks very promising. It is concluded that until now rheumatic fever is still a major health problem especially in many developing countries. The development of management and prophylaxis measures is still needed. Key Words : rheumatic fever, rheumatic heart disease, penicillin prophylaxis, imnumoprophylaris, carditis

Takikardi Supraventrikular Paroksismal pada Anak - Peranan Penyakit Infeksi dan Kemungkinan Kenaikan Kadar Enzim dalam Serum

ABSTRACT: A. Samik Wahab. Supravengricular tachycardia in children: The role of infectious diseases and its relationship to serum enzyme In twenty four children an episode of supraventricular tachycardia occurred before 15 years (median age 12 months). Fourteen male and 10 female children were reviewed, of which one had a congenital heart disease. Lown-Ganong-Levine syndrome was present on surface ECG in 1/24 (4 per cent). Forty six per cent of children were undernourished as determined by the weight to height ratio according to the WHO criteria (1983), and 58 per cent of them were anemic, according to the WHO criteria (1972). All children have had fever, mostly above 38.5° C. In ten children with an SVT episode the serum enzyme level, was also studied, i. e. the serum glutamine oxalo-transaminase (SCOT), lactate dehydrogenase (LDH) and creatinine phosphokinase (CPK). Five out of 11 children had a high serum enzyme level, ranging 25-68 U/dI (mean: 40.88 ± 16.30) for GOT, 315 889 U/dI (mean: 482 ± 232.53) for LDH, and 57-581 U/d1 (mean: 251.33 ± 287.02) for CPK, instead of a normal level range of 1-19 U/c11, 80-240 U/dl and 0-50 U/dl respectively. It is concluded that the episode of SVT often occurs in children with infection, especially gastrointestinal intention, meningitis, encephalitis. bronchopneumonia and septicemia. Fever, undernutrition and anemic status are considered as precipitating factors. Preexitation syndromes, such as WPW and LGL syndromes, were infrequently found. Digitalis treatment has to be changed with other preparations which are often used such as calcium antagonist or ATP, especially for patients who do not respond to digitalis. Physicians who work in the surgery department, should be aware of an SVT episode, especially if the children have fever, undernutrition and anemia. Key Words: supraventricular tachycardia - anemia - undernutrition - WPW syndrome - LGL syndrom

Blokade Cabang Berkas Kiri (Left Bundle Branch Block) pada Miokarditis Difteri

Left bundle branch block in diphtheritic myocarditis A case study Left bundle branch block is very rare in children. A boy, 5 years old with diphtheritic myocarditis had left bundle branch block in ECG pattern during the first days in hospital. He had received basic DPT vaccination 4 1/2 years ago, when his age was three months. The prognosis of left bundle branch block in diphtheritic myocarditis is usually poor. However, as he received DPT vaccination in the last 5 years the prognosis was tending to good. After 11 days hospitalisation, the ECG pattern suddenly reversed to normal. The follow up- through outpatient department has no further complications, despite he discharged with still high LDH serum leveL The purpose of this study is to report a very rare case, and this case hopefully to be the last diphtheritic disease in Yogyakarta, due to a very good coverage of vaccination. Key Words: diphtheria diphtheritic myocarditis left bundle branch block DPT vaccination LDH enzym

Insidensi streptococcus beta-haemolyt cus pada anak dengan pharyngitis

SUMMARY Pharynx-swabs using filter paper strip method were done on children with pharyngitis, and 3,8% positive Streptococcus beta-haemolyticus group A and 4,8% positive non-group A werefound. Clinical manifestations were: fever (100%), hyperaemic pharynx with exudate 54%, without exudate 46% and with cough 27%. Blood examinations were done on 40 positive cases of which 60% showed leucocytosis. Months with a high incidence were: January â February 27%, May â June 36% and September\u27 â October 27%

Pericarditis With Effusion in Children

Two cases of pericarditis with effusion admitted to the Department of Child Health, Gadjah Mada University Hospital were presented. The suspicion was based on the presence of pericardial friction rub for the first case, and the presence of cardiac enlargement and liquid line (on X-ray) for the second case. Pericardiocentesis was performed to confirm the diagnosis and for treatment. An accurate etiological diagnosis could not be made due to lack of laboratory facilities. The treatment was based on clinical and pathological finding

Studies of Blood Pressure in Primary School Children in a Rural Area in Indonesia

ABSTRACT: Tekanan darah pada anak sekolah dasar di daerah pedesaan Indonesia Telah diukur tekanan darah pada 506 anak sekolah yang berumur antara 6-14 tahun dan terdiri atas 227 anak laki-laki dan 279 anak wanita. Sampel ini diambil secara duster dan acak dari suatu populasi anak sekolah di pedesaan. Tekanan darah ini diukur pada anak sekolah clari 17 sekolah dasar kecamatan Sewon, Bantu!, Daerah lstimewa Yogyakarta. 17 sekolah ini merupakan sampel dari seluruh sekolah dasar yang ada di kecamatan Sewon. Alat yang dipakai untuk mengukur adalah sphygmomanometer bahan air raksa, dan pengukuran dilakukan oleh hanya sacs orang. Semua anak mulaâ¢mula diukur tekanan darahnya pada posisi duduk, kemudian pada posisi telentang. Hasilnya pada posisi duduk tekanan darah sistolik berbeda secara bermakna antara anak lakilaki dan wanita, kecuali pada anak umur 6 tahun. Demikian juga tekanan darah diastolik, kecuali pada anak umur 14 tahun. Tekanan darah pada posisi duduk dan tidur berbeda bermakna balk pada laki-laki maupun pada wanita. Key Words: blood pressure - rural primary school children - systolic pressure - diastolic pressur

Fibrilasi Atrium pada Anak:Penelitian Kasus

ABSTRAK A. Samik Wahab-Atrial fibrillation in children: Case study Atrial fibrillation is very rare in children. Two children are described, although both were initially in congestive heart failure due to active carditis and were difficult to manage, but all have completely recovered. In addition to digitalis therapy all cases had quinidine, with therapeutic goal of controlling the heart rate rather than abolishing the fibrillation. One case died at home, 12 days after discharge from hospital and one recovered from fibrillation until now. Mitral and tricuspidal an nuloplasty have been performed to the second case, and the result is very satisfactory. Key Wards: atrial fibrillation â rheumatic hear t diseases â rheumatic feverâ congestive heart failure â quinidine therap

Blokade Jantung Total pada Anak

The diagnosis of complete heart block is based on electrocardiogram. There would be few or even no cases missed if electrocardiograms were made of all slow heart rate infants and children. The history, physical signs, and Xâ¢ray would lead to the recognition of congenital and acquired complete heart block as an isolated, uncomplicated, anomaly. Incomplete history in healthy asymptomatic older children may cause difficulty in differentiating congenital or acquired origin. The conduction defect is usually discovered accidentally in healthy, asymptomatic children. Adams-Stokes syncopes rarely happen, even in the young. An obstetrician may detect a slow fetal heart rate, in which fetal electrocardiography and echocardiography have diagnostic value. A history of maternal lupus (SLE) or collagen disease or connective tissue disease (CTD) is another-major important diagnostic. The arterial pulse is very slow, the pulse amplitude wide and rhythm regular, The jugular venous pulse is intermittent cannon waves due to independent A waves which are asynchronous with and more rapid than the carotid pulse. The diagnosis is confirmed by electrocardiogram, the P waves and QRS complexes have no constant relation. The QRS duration is normal if the heart beat is initiated high in the His bundle and prolonged if the pacemaker is located below it. The treatment is directed especially to Adams-Stokes syncope. Digitalisation and other anticongestive measures may be indicated if cardiac failure occurs. In patients with recurrent Adamsâ¢Stokes attacks, resting ventricular rate of 40 beats per minute or less probably should be paced. The prognosis for congenital and acquired heart block is usually favourable. Key Words: heart block -- a-v block -- congenital heart disease -- acquired heart disease --rheumatic heart diseas

Tetralogi Fallot: Penelitian Sebelum dan Sesudah Operasi

ABSTRACT A. Samik Wahab-Tegralogy of Fallot: Pro-and post-surgical case study Defects in the ventricular septum with obstruction to right ventricular outflow encompass a wide anatomic, physiologic and clinical spectrum. Large ventricular septal defects occur with pulmonic stenosis that varies from mild to severe to complete (pulmonary atresia). Small ventricular septal defects occur with mild to severe pulmonic stenosis. The most familiar and prevalent combination is tetralogy of Fallot with the incidence of approximately 0.4 to 0.6 per 1000 live births. The following illustrates four cases of Fallot\u27s tetralogy with a wide anatomic, physiologic and clinical variations. The first case is a small ventricular septa\u27 defect along with severe pulmonic stenosis, the fourth case, however, comprises a large VSD and pulmonary atresia, while in the others the anatomic variations are in between. Hypoxic spells are important aspects of the history in Fallot\u27s tetralogy. Spells are an alarming episode that should be treated as an emergency. Knee-chest position, squatting or sitting with legs drawn underneath can afford to relief dyspnea. The best treatment, however, is surgical treatment, indicated in all patients with Fallot\u27s tetralogy. The result of this surgical treatment up to now is very satisfactory. Key Wards: tetralogy of Fallot - pulmonic stenosis - ventricular septal defect - pulmonary atresia - bicuspid a pulmonali

Pulmonary Artery Hypertension Associated with HIV Infection in Nine Year-Old Child

Pulmonary arterial hypertension (PAH) is a serious life threatening and severe complication ofHIV infection. A PAH presentation in patient with HIV tends to non specific, result in recognizeddiagnosis at a later stage. A 9 year-old HIV patient came to Pediatric Clinic with a chief complaint of worsening dyspneu for 1 month, leg edema and difficulty lying on a flat bed. Patient showed signs and symptoms that lead to pulmonary hypertension. An ECG findings were sinus rhythm, right axis deviation, and right ventricular hypertrophy. Echocardiography findings showed rightventricular and atrial enlargement, and high probability of pulmonary hypertension. Blood examination showed CD 4 was 84 cells/μL. The patient was managed as pulmonary arteryhypertension associated with HIV (HIV-PAH) infection.The patient was admitted for 3 weeksand eventually discharged with relieve condition