Profile of Kawasaki Disease in Adolescents: Is It Different?

Background: there is clearly growing population of young adults with potentially important coronary artery disease after Kawasaki disease (KD) during childhood, and cardiologist must be prepared to take care for them. As Kawasaki disease in adolescent and adult is rare and under-recognized, it is important to study data on patient presentations which may permit development of diagnostic criteria and treatment guidelines for this age group.This study aimed to compare the clinical profile of KD between adolescents (>10 years of age) and children ≤10 years. Methods: This is a cross sectional study. A total of 1150 KD cases (age 1-192 months) during the period of January 2003-December 2016 were analyzed. The clinical profile of subjects aged >10 years (adolescents) and  ≤10 years (children) at acute phase of KD were compared. Results: we found 17 cases of KD in adolescents among 1150 total cases (1.5%). Incomplete KD was more often seen in adolescents compared to children ≤ 10 years of age (59% vs. 29%). Some clinical features were more frequently seen in children than in adolescents, e.g. conjunctivitis (85% in ≤ 10 years of age vs. 65% in > 10 years), mucosal changes (94% vs. 77%), rash (86% vs. 59%), and hand/foot changes (68% vs. 41%). While other clinical features were more often seen in adolescents, e.g., cervical lymphadenopathy (82% vs. 39%) and coronary dilatation (47% vs. 29%). Laboratory results (hemoglobin, leukocytes, erythrocyte sedimentation rate and C-reactive protein) did not differ much between the two groups. Conclusion: Kawasaki disease in adolescents has some different clinical profile from that of younger age. Majority of adolescent patients have incomplete presentation. Some clinical features such as conjunctivitis, mucosal changes, rash, and hand/foot changes are more often seen in children ≤ 10 years compared to in adolescents, while cervical lymphadenopathy and coronary dilatation are more frequently seen in adolescents. The ratio of male to female is much higher in adolescents

Hepatitis B antibody titers in Indonesian adolescents who received the primary hepatitis B vaccine during infancy

Backgi-ound Hepatitis B (HB) has been classified as moderate-tohighly endemic in Indonesia. HB vaccination, the most effective method to prevent HB viral transmission, induces protective antibodies against HB surface antigen (anti-HBs). However, these antibodies decline in titer over time. Studies on the duration of protection and the prevalence of n on-responders in Indonesian adolescents have been limited. Objectives To determine anti-HBs titers in 15-17-year old Indonesian adolescents given primary HB vaccine during infancy and the prevalence of non-responders after a HB vaccine booster dosage. Methods This cross-sectional study was performed from February to September 2008 on adolescents aged 15-17 years in three senior high schools in Jakarta who received complete primary HB vaccines during infancy, based on parents' recall. Investigations included HB vaccination history, anthropometric measurements, and blood tests for anti-HBs before and 4-6 weeks after a booster dose ofHB vaccine. Results Of 94 subjects, 35 had protective anti-HBs and 59 had undetectable anti-HBs. A booster dose was administered to 5 8 of the n on-protected subjects, of which 33 showed anamnestic responses. However, 25 subjects failed to generate protective anti-HBs. Taking into consideration the adolescents with protective anti-HBs before and after the booster dose, serologic protection was demonstrated in 73%. Non-responder prevalence was 27%. The high prevalence of non-responders may indicate bias of parents' recall. Conclusion Protective anti-HBs is detected in less than half of Indonesian adolescents given primary HB vaccine during infancy. Following booster dosage, anamnestic responses are n oted in onethird of subjects. The prevalence of non-responders is 27%, but confirmation with further study is needed

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

Sildenafil for pulmonary hypertension due to left-toright shunt after corrective procedure

Background Pulmonary arterial hypertension (PAH) is a common complication seen in those with a left-to-right shunt congenital heart defect (CHD). Corrective procedures by surgery or catheterization are the therapies of choice for reversible PAH. Since morbidity and mortality due to PAH after correction is high, sildenafil has been used as a selective vasodilator of the pulmonary artery, in order to decrease pulmonary arterial pressure. Objectives To evaluate the effect of sildenafil on pulmonary arterial pressure and clinical outcomes after left-to-right shunt CHD corrective procedures. Methods Left-to-right shunt patients aged < 18 years scheduled for corrective treatment were randomized in a double-blind fashion, to receive either oral sildenafil or placebo, given on days 3 to 30 after the corrective procedure. Clinical and pulmonary arterial pressures were evaluated by echocardiography before, 3 days after, and 30 days after the corrective procedure. Results From July 2013 to June 2014, 36 patients were included in the study: 17 in the placebo and 19 in the sildenafil groups. There were no differences in pulmonary arterial pressure or in clinical outcomes after corrective procedure between the two groups. There were no adverse events during the treatment. Conclusion Sildenafil has little effect on decreasing pulmonary arterial pressure, as most of our subjects seem to have hyperkinetic PAH. As such, pulmonary arterial pressure returns to normal soon after corrective procedures

Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country?

Background Most children undergoing cardiac surgery for congenital heart disease (CHD) in developing countries are malnourished. Malnutrition is known as a co-morbidity factor that might predict and influence outcomes after surgery. Objectives To evaluate the effect of malnutrition and other associated risk factors on post-operative outcomes in children with CHDs underwent cardiac surgery. Methods We conducted a retrospective cohort study in a single center tertiary pediatric cardiac intensive care unit (PCICU) in Indonesia. Our cohort included all children between 5 and 36 months of age undergoing congenital heart surgery with cardiopulmonary bypass from November 2011 until February 2014. Outcomes measured were the length of intubation and the length of ICU stay. Variables for potential influence investigated were the nutritional status, age, gender, type of cardiac anomaly (acyanotic vs. cyanotic), Aristotle score, cardiopulmonary bypass time, aortic cross-clamp time, and Pediatric Risk of Mortality (PRISM) III score. Results Out of 249 patients included, 147 (59%) showed malnourishment on admission. Malnourished patients were significantly younger in age, presented with an acyanotic heart defects, and had higher PRISM III score. Additionally, they also had a longer mechanical ventilation time and ICU stay than those with a normal nutritional status. After adjusting for various variables using a multiple logistic regression model it could be demonstrated that a higher Z-score for weight to age was a significant protective factor for the intubation time of more than 29 hours with an odds ratio of 0.66 (95% CI 0.48 to 0.92, P = 0.012). Non-malnourished patients had a 49% significantly higher chance for extubation with a hazard ratio of 1.49 (95% CI 1.12 to 1.99, P= 0.007). Conclusion Malnourishment is clearly associated in a linear fashion with longer mechanical ventilation and ICU stay. As one of significant and potentially treatable co-morbidity factors, prevention of malnourishment by early diagnosis and optimal timing for surgery is important

Effectiveness of Mindfulness Therapy among Adolescent with Conduct Disorder in Jakarta, Indonesia

AbstractBackgr*ound and objectives: The prevalence of adolescent conduct disorder (CD) among school in Jakarta is 26,1% leading to high incidence of student brawls. Up until now, there is no structured module for CD intervention that can be done by teacher, thus mindfulness therapy is used in scholl to reduce such incidence. The objective of this study is to asses the effectiveness Learning of self-regulation in mindfulness therapy conducted by school counselor inmitigating their involvement in brawls and other forms of violence. Changes in behaviour and cortisol level are used as indicators of success. Met*hod: subject were randomly assigned into treatment as usual (with school counselors) and into Mindfulness training by counselors supervised by a psychiatrist. Cortisol level was checked before and after treatment. Behavioral changes were reported trough a conduct disorder instrument developed for the study. Outcome data was analized using Chi-square, Odd Risk Ratio calculation, and the General Linear Model Repeated Measures. Results and conclusion: 103 students completed the study (intervention n=53 control n=50) after 8 weeks, showing the effectiveness of Mindfulness therapy by NNT=2, RR=3,40 (2,04-5,65. The secondary results showed a decrease of anti-social behaviour measured by TCD-AM and a significant decrease of serum cortisol level (p0,00) compared to the control group. Minfulness therapy recomended to manage anti-social behavior in school. Learning of self-regulation in mindfulness therapy resulted in improvement of emotional and behavioral control among adolescent with conduct disorder. Minfulness therapy can be conducted by school counselors after appropiate training. This study is limited among male adolescents with mild and moderate history of conduct disorder. Girls and the experienced severe conduct disorders were not included in study

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