161 research outputs found
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
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
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
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< 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 < 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< 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
Kadar Transforming Growth Factor β-1 Urin pada Berbagai Keadaan Proteinuria
Latar belakang. Proteinuria masif pada sindrom nefrotik (SN) akan menginduksi suatu rentetan reaksi biologis di tubular proksimal. Reaksi ini mengaktivasi peptida vasoaktif dan produksi sitokin, seperti TGF-β1. Di dalam urin, TGF-β1 urin merupakan sitokin fibrogenik yang pluripoten, yang melalui beberapa patomekanisme menyebabkan fibrosis interstisial dan glomerulosklerosis yang pada akhirnya menimbulkan gagal ginjal.
Tujuan. Mengetahui kadar TGF-β1 urin pada berbagai keadaan proteinuria, yakni pada anak dengan sindrom nefrotik sensitif steroid (SNSS), dalam keadaan remisi maupun relaps, dan pada anak dengan sindrom nefrotik resisten steroid (SNRS).
Metode. Penelitian dengan desain potong lintang ini dilakukan di 8 pusat ginjal anak di Indonesia. Subyek penelitian ini terdiri atas 34 anak dengan SNSS steroid remisi, 31 anak dengan relaps, 55 anak dengan SNRS, dan 35 anak tanpa penyakit ginjal sebagai kontrol. Kadar proteinuria dan TGF-β1 urin diperiksa pada sampel urin sewaktu yang diambil pagi hari. Kadar TGF-β1 urin diperiksa dengan metode enzyme-linked immunosorbent assay (Quantikine kit for human TGF-β1 immuno assay; R&D Systems, Mineapolis, MN). Kadar proteinuria kuantitatif diperiksa dengan cara kolorimetri (Randox kit; Randox Laboratories, United Kingdom)
Hasil. Kadar proteinuria tertinggi didapatkan pada SN relaps, yang secara bermakna lebih tinggi daripada kadar SNRS. Namun, kadar TGF-β1 urin pada SN relaps sama tinggi dengan kadarnya pada SNRS yang secara bermakna lebih tinggi daripada kadarnya pada SN remisi. Kadar TGF-β1 urin pada SN remisi tidak berbeda dengan kadarnya pada anak tanpa penyakit ginjal. Terdapat korelasi positif antara kadar TGF-β1 dan protein urin (r=0,649 ;p<0,0001).
Kesimpulan. Kadar TGF- β1 urin pada anak dengan SN relaps sama tingginya dengan kadar TGF- β1 urin pada SNRS, yang secara bermakna lebih tinggi bila dibandingkan dengan kadar pada anak dengan sindrom nefrotik remisi, maupun anak tanpa penyakit ginjal
Oral prednisolone for acute otitis media in children (OPAL study): A pilot, pragmatic, randomised, open-label, single-blind, controlled study
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
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