Correlation between chest x-ray findings and outcomes of patients with mechanical ventilation

Background Most infants and children admitted to the pediatric intensive care unit (PICU) have respiratory distress and pulmonary disease as underlying conditions. Mechanical ventilation may be used to limit morbidity and mortality in children with respiratory failure. Objective To assess a correlation between chest x-ray findings and outcomes of patients with mechanical ventilation. Methods This retrospective study was held in Dr. Kariadi Hospital, Semarang, Indonesia. Data was collected from the medical records of children admitted to the PICU from January to December 2010, who suffered from respiratory distress and used mechanical ventilation. We compared chest x-ray findings to the outcomes of patients. Radiological expertise was provided by radiologists on duty at the time. Chi-square and logistic regression tests were used for statistical analysis. Results There were 63 subjects in our study, consisting of 28 males and 35 females. Patient outcomes were defined as survived or died, 43 subjects ( 68%) and 20 subjects (3 2%), respectively. Chest x-ray findings revealed the following conditions: bronchopneumonia 48% (P=0.298; 95%CI 0.22 to 1.88), pleural effusion 43% (P=0.280; 95%CI 0.539 to 4.837) , pulmonary edema 6% (P=0.622; 95%CI 0.14 to 14.62) and atelectasis 3% (P=0.538; 95%CI 0.03 to 7 .62). None of the chest x-ray findings significantly correlated to patient outcomes. Conclusion Chest x-ray findings do not correlate to patient outcomes in pediatric subjects with mechanical ventilation in the PICU of Dr. Kariadi Hospital, Semarang, Indonesia

Combination of Aspartate Aminotranferase and Tumor Necrosis Factor-alfa as Non Invasive Diagnostic Tools for Non Alcoholic Steatohepatitis (NASH)

Aim: to develop a non-invasive diagnostic test for non-alcoholic steatohepatitis NASH. Methods: this is a cross-sectional study on non-alcoholic fatty liver disease (NAFLD) subjects. Sample was taken by consecutive sampling method. Diagnostic criteria of NAFLD were confirmed by liver biopsy. Clinical variables include metabolic syndrome, aspartate aminotransferase (AST), alanine aminotransferase (ALT), adiponectine, TNF-alfa, insulin, homeostatic model assessment insulin resistance (HOMA-IR) index and liver biopsy. Patients were divided into two groups based on their liver biopsy, group 1: Non-NASH (NAFLD activity score 4). Statistical analyses were performed using Student’s t-test, Mann Whitney U, chi-square, the ROC curve, sensitivity and specificity test. Results: fifty NAFLD patients were recruited, 30 males and 20 females. Among these patients, 12 (24%) had type 2 diabetes, 36 (72%) had metabolic syndrome, the remaining 2 (4%) did not fulfilled metabolic syndrome. Liver biopsy confirmed 21 (42%) non- NASH and 29 (58%) NASH respectively. Level of AST and ALT, plasma level of adiponectine and TNF-alfa were statistically different between two groups. The AST level (>25 U/L) in combination with TNF-a (>3.28 pg/cc) demonstrated a good diagnostic accuracy for NASH (Accuracy 82%, Sensitivity 76%, Specificity 90%, PPV 92%, and NPV 73%). Conclusion: the combined diagnostic tests of AST and TNF-alfa plasma levels demonstrated a good accuracy for the detection of NASH among NAFLD patients. This combination test can be used as a noninvasive method to diagnose NASH.Key words: AST, TNF-a, diagnostic test, NASH

KARAKTERISTIK DAN KETAHANAN HIDUP 2 TAHUN PENDERITA KANKER PARU DI RS KANKER DHARMAIS PERIODE JANUARI 1998-NOVEMBER 2001

Kanker yang banyak menimbulkan kematian diseluruh belahan dunia adalah kanker paru. Dari tahun ke tahun jumlahnya men i ngkat baik di negara maju seperti Amerika Serikat, Eropa dan Jepang maupun d i negara berkembang tennasuk Indonesia. Di Amerika Serikat kematian karena kanker paru mencapai 36% dari seluruh kematian kanker pada laki-laki, merupakan urutan pertama penyebab kematian pada laki-laki (Mangunnegoro, 1990). Mayo Lung mendapatkan kematian akibat kanker paru terhadap penderita kanker paru didapatkan angka 3, 1 per !000 orang tiap tahun (Alsagaf, 1995). Di Indonesia penyakit kanker paru menduduki peringkat ke-3 atau ke-4 diantara penyakit keganasan d i rumah-rumah sakit. Atmanto ( 1992) menyatakan kanker paru merupakan penyakit dengan keganasan tertinggi d iantara jenis kanker lainnya di Jawa Timur dengan angka Case Fatality Rate (CFR) sebesar 24, I %. Pada Tabun 1998 di RS Kan.ker Dharmais, kanker paru menempati urutan kedua terbanyak setelah kanker payudara, yaitu sebanyak 75 kasus (Nasar, 2000) Seperti kanker pada umumnya hingga saat ini penyebab yang pasti dari kanker paru masi.h belum diketahui, namun ada beberapa faktor yang dicurigai sebagai faktor risiko terjadinya kanker paru. Faktor tersebut adalah inhalasi zat karsinogen seperti: rokok, polusi udara, zat hasil industri tertentu seperti asbes, acrylonitri/e, vinil chloride, arsen dll. Inhalasi zat karsinogen yang paling banyak pada penderita kanker paru adalah karena kebiasaan merokok, di mana di dalam rokok tersebut terdapat kandungan "tar", suatu persenyawaan hidrokarbon aromatik polisikJik (Alsagaf, 1995) Sebagai tolok ukur keberhasilan pengobatan kanker adalah angka ketahanan hidup (year survival rate). Ketahanan hidu p pada penyak it kanker dengan keganasan yang tinggi seperti kanker paru adalah ketahanan hidup 1 tahun (one year survival) dan ketahanan hidup 2 tahun ( two year survival) serta ketahanan hidup Lung cancer is the health problem in developed countries and also in developing countries. Till nowadays there be no research about year survival rate at lung cancer patient in Dharmais Cancer Hospital. The goal of this research is to get information the characteristics and the probability of 2 year survival of the lung cancer patients at Dharmais Cancer Hospital. The design of this research is longitudinal study. Data were collected from medical record lungs cancer patients on Januari 1998 to November 2001. The sample was 181 patients. Data was collected from medical record as well as by telephoning to establish how long each lung cancer patient survived. The result of this research indicate that the 2- year survival rate for lung cancer patients at Dharmais Cancer Hospital was 14,55% with a median survival rate of 5 months.   Keywords: survival, lung cancer, medical recor

Chest x-ray findings and outcomes of children with suspected ventilator .. associated pneumonia

Background Ventilatorassociated pneumonia (VAP) is a nosocomial infection in patients who have received mechanical ventilation (MV), either by endotracheal intubation or tracheostomy, for more than 48 hours. YAP represents 80% of all hospitalacquired pneumonias. VAP incidence varies from 5.1 %33.3%. The modified clinical pulmonary infection score is a criteria for diagnosing suspected YAP and typically includes radiographic evidence. YAP is associated with significant morbidity and mortality. Objective To determine the relationship between chest xray findings and outcomes in children Mth suspected VAP. Methods This retrospective study was held in Dr. Kariadi Hospital from January - December 2010. Data was collected from medical records of pediatric ICU (PICU) patients with suspected VAP. Chest xray findings and patient outcomes were recorded. Xray findings were assessed by the onduty radiologist. Chi square test was used for statistical analysis. Results Subjects were 30 children consisting of 14 males and 16 females. Patient outcomes were 23 patients survived and 7 patients died. Chest xray findings were categorized into the following groups and compared to patient survivability: diffuse infiltrates 76.7% (OR0.694; P0.532; 95% CI 0.102 to 4.717), localhed infiltrates 13.3% (OR4.200; P 0.225; 95% CI 0.470 t037.49), and no infiltrates 10% (OR 1.222; P 0.436; 95% CI 0.593 to 0.926). None of the xray findings had a significant correlation to patient outcomes. Conclusion There was no significant relationship between chest xray findings and outcomes in children with suspected VAP. [Paediatr rndones. 2012;52:233-8]

Initial brain CT scan and shunting outcomes in children with hydrocephalus

Background Hydrocephalus is one of the most common clinical conditions affecting the central nervous system, with a congenital hydrocephalus incidence of 3-4 per 1000 births. Incidence of acquired types of hydrocephalus is unknown. Brain computerised tomography (CT) scan can be used to assess the size of ventricles and other structures. Shunting has long been performed to alleviate hydrocephalus. Shunting has dramatically changed the outlook of children with hydrocephalus, with many of them having normal life expectancies and attaining normal intelligence. Objective To determine the outcomes of shunting in children with hydrocephalus based on initial brain CT scan. Methods We performed a cross-sectional study in Dr. Kariadi Hospital. Initial brain CT scan data were collected from the medical records of children admitted to the Neurosurgery Ward for ventriculoperitoneal (VP) shunt surgery from January 2009 to December 2010. We studied the brain CT scan findings before VP shunt surgery and the outcomes of the children after VP shunt surgery. Radiological findings were determined by a radiologist responsible at that time. Results This study consisted of 30 subjects, 19 boys and 11 girls. Initial brain CT scans to assess disease severity revealed the fo llowing conditions: lateral ventricle dilatation in 7 subjects, lateral and third ventricle dilatation in 16 subjects, and lateral, third and fourth ventricle dilatation in 7 subjects. After VP shunt surgery, 3 subjects in the lateral, third and fourth ventricle dilatation category died. They were grouped according to their condition. Group 1 consisted of subjects with only lateral ventricle dilatation and subjects with lateral and third ventricle dilatation (23 subjects), while group 2 consisted of subjects with lateral, third and fourth ventricle dilatation (7 subjects). More survivors were found in group 1 than those in group 2. Conclusion Less severe initial brain CT scan findings are associated with better shunting outcomes children with hydrocephalus