PERBANDINGAN ANTARA BERBAGAI DERAJAT HISTOPATOLOGI BIOPSI HATI DENGAN BILIRUBIN DIREK, ASPARTAT AMINOTRANSAMINASE, ALANIN AMINOTRANSAMINASE DAN ALBUMIN SERUM PADA ANAK DENGAN KOLESTASIS

Latar belakang: Biopsi hati merupakan prosedur diagnostik yang rutin dilakukan di RSUD Dr. Soetomo Surabaya. Prosedur ini merupakan alat yang bernilai untuk diagnosis, prognosis, dan tatalaksana penyakit parenkim hati. Analisis antara gambaran histopatologi dengan bilirubin direk, aspartat aminotransaminase, alananin aminotransferase, dan kadar albumin belum pernah dilakukan. Tujuan: Untuk menganalisis berbagai gambaran histopatologi dengan bilirubin direk, aspartat aminotransaminase, alanin aminotransferase, dan kadar albumin pada anak dengan kolestasis. Metode: Penelitian retrospektif dari 51 kasus kolestasis yang didiagnosis dan diterapi mulai Januari 2011 sampai Desember 2016. Seluruh biopsi dinilai derajat kerusakannya menggunakan sistem skoring semi-kuantitatif dari Muthukanagarajan dkk. (dikategorikan menjadi fibrosis, proliferasi duktus biliaris, kolestasis, dan malformasi duct plate). Derajat seluruh gambaran dibandingkan dengan bilirubin direk, AST, ALT, dan kadar albumin. Analisis statistik menggunakan uji one-way anova, Kruskal-Wallis, unpaired-t. Signifikan jika p<0.05. Metode: Didapatkan 30 anak laki-laki dan 21 perempuan dengan karakteristik: usia 3(1-9)bulan, berat badan 5(1,41)kg. Derajat fibrosis: 47% negatif, 22% ringan, 31% sedang, 0% berat; Proliferasi duktus biliaris: 57% negatif, 21% ringan, 14% sedang, 8% berat; Kolestasis: 0% negatif, 14% ringan, 69% sedang, 18% berat; Malformasi duct plate: 63% negatif, 37% positif. Kadar bilirubin direk berbeda signifikan dengan derajat proliferasi duktus biliaris (P=0.024). Tidak didapatkan perbedaan signifikan antara kadar AST dengan seluruh derajat gambaran histopatologi. Kadar ALT berbeda signifikan dengan derajat fibrosis (P=0.043). Kadar albumin berbeda signifikan dengan derajat fibrosis (P=0.000), derajat proliferasi duktus biliaris (P=0.006) dan malformasi duct plate (P=0.037). Kesimpulan: Terdapat perbedaan kadar bilirubin direk, ALT, dan albumin dengan derajat kerusakan berbagai gambaran histopatologi pada anak dengan kolestasis

First-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae in Indonesia

Background Diphtheria has been reported as an outbreak in some regions in Indonesia, most especially in East Java Province. Resistance to penicillin, erythromycin, and other antibiotics, single or multiple, has been reported in several studies. This study aims to evaluate the first-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae isolates. Methods This descriptive observational study was performed from August to November 2018. C. diphtheriae isolates were collected from diphtheria patients and carriers in East Java from 2012 to 2017 and kept at the Balai Besar Laboratorium Kesehatan Daerah Surabaya or the Public Health Laboratory of Surabaya. Sample selection was done by random cluster sampling. The sensitivity test by E-test®of the five antibiotics (penicillin, oxacillin, erythromycin, azithromycin, and clarithromycin) was done to determine the minimum inhibitory concentration (MIC). The Clinical and Laboratory Standards Institute M45A (2015) Corynebacterium spp. for penicillin and erythromycin was used as standard. Results From 114 targeted isolates, 108 were viable and toxigenic. The E-test was performed on the viable isolates. The majority of the hosts were male (58.3%), with median (range) age of 6.5 (1–14) years. Half of the samples were from the 1 to 5-year-old age group. The isolates were acquired much more from patients (78.7%) than carriers (21.3%) and from pharyngeal swab (74.1%). Most of these isolates were from Madura Island (47.2%) and the northern and eastern parts of the province (horseshoe area). Mitis isolates were the major variant (76.9%). The susceptibility pattern of C. diphtheriae to erythromycin was better than that to penicillin. The E-test result for penicillin was 68.52% susceptible, 31.48% intermediate, and 0% resistant (MIC range,  256 μg/L) was 85.2% susceptible, 12% intermediate, and 2.8% resistant The MIC range for oxacillin was 1 to 96 μg/L, while for both azithromycin and clarithromycin were  256 μg/L. Conclusion The susceptibility rate of C. diphtheriae to erythromycin is higher than that to penicillin. The regular update of antibiotic selection to the national guidelines is recommended. The MIC reference standard to azithromycin and clarithromycin is also needed

Stunting as a Synonym of Social Disadvantage and Poor Parental Education

Socially, economically, politically and emotionally (SEPE) disadvantaged children are shorter than children from affluent background. In view of previous work on the lack of association between nutrition and child growth, we performed a study in urban schoolchildren. We measured 723 children (5.83 to 13.83 years); Kupang, Indonesia; three schools with different social background. We investigated anthropometric data, clinical signs of malnutrition, physical fitness, parental education, and household equipment. Subjective self-confidence was assessed by the MacArthur test. The prevalence of stunting was between 8.5% and 46.8%. Clinical signs of under- or malnutrition were absent even in the most underprivileged children. There was no delay in tooth eruption. Underprivileged children are physically fitter than the wealthy. The correlation between height and state of nutrition (BMI_SDS, skinfold_SDS, MUAC_SDS) ranged between r = 0.69 (p < 0.01) and r = 0.43 (p < 0.01) in private school children, and between r = 0.07 (ns) and r = 0.32 (p < 0.01) in the underprivileged children. Maternal education interacted with height in affluent (r = 0.20, p < 0.01) and in underprivileged children (r = 0.20, p < 0.01). The shortness of SEPE disadvantaged children was not associated with anthropometric and clinical signs of malnutrition, nor with delay in physical development. Stunting is a complex phenomenon and may be considered a synonym of social disadvantage and poor parental education

Prediction of histopathological grades of liver pathology in cholestasis by direct bilirubin, aspartate aminotransferase, alanine aminotransferase and albumin level

Abstract Background: Liver biopsy, a routine diagnostic procedure in Dr. Soetomo General Hospital Surabaya, is a valuable tool in the diagnosis, prognosis, and management of parenchymal liver disease. However, the correlation between histopathological features and direct bilirubin, aspartate transaminase (AST), alanine transaminase (ALT) and albumin level has not yet been established. Objectives: To correlate various histopathological features with direct bilirubin, AST, ALT and albumin level of children with cholestasis. Method: This is a retrospective study of 51 cases of cholestasis diagnosed and treated from January 2011 to December 2016. All biopsies were reviewed and graded by a semi-quantitative scoring system according to Muthukanagarajan et al and categorized into fibrosis, bile duct proliferation, cholestasis and duct plate malformation. Degrees of all features were compared with direct bilirubin, AST, ALT, and albumin level. Statistical analysis used one way ANOVA, Kruskal-Wallis and unpaired t-test. p<0.05 was considered significant. Results: There were 30 males and 21 females with a median age of 3 (1-9) months and a mean weight of 5 (1.41) kg. Degree of fibrosis was negative (47%), mild (22%), moderate (31%) and severe (0%). Bile duct proliferation was negative (57%), mild (21%), moderate (14%) and severe (8%). Cholestasis was negative in 0%, mild in 14%, moderate in 69% and severe in 18%; duct plate malformation was negative in 63% and positive in 37%. Direct bilirubin level showed significant difference with degree of duct proliferation (p=0.024). There was no significant difference of AST level with all degrees of histopathological grade. ALT level showed significant difference with degree of fibrosis (p=0.043). Albumin level showed significant difference with degree of fibrosis (p=0.000), degree of duct proliferation (p=0.006) and duct plate malformation (p=0.037). Conclusions: This study showed that while the direct bilirubin level was significantly associated with the degree of duct proliferation and the ALT level was significantly associated with the degree of fibrosis, the albumin level was significantly associated with the degree of fibrosis, degree of duct proliferation and degree of duct plate malformation. Sri Lanka Journal of Child Health, 2023: 52(2): 142-14