The impact of excessive weight gain on hypertension, steroid induced diabetes, and disease parameters in pediatric systemic lupus erythematosus patients

Systemic inflammation, corticosteroids therapy, and reduced physical activity may predispose the accumulation of body fat in patients with systemic lupus erythematosus (SLE). However, less is known about its impact in children.(1,2) This study aims to explore the impact of excessive weight gain on pediatric SLE patients

Hemofilia dengan perdarahan intrakranial

Sunarto & Sumadiono - Hemophilia with intracranial bleeding - A case report A hemophiliac boy was hospitalized due to head injury in the previous sixteen days. On admission the\u27 consciousness decreased and visus of both eyes was 1/on. CT scan showed blood clot in the area of dorsomedial of medial cerebral arteria and sign of hydrocephalus. A surgical procedure could not be taken due to lack of facilities (antihemophilic factor supply and assay of factor VIII activity). The patient was given 6 cryoprecipitate everyday and supportive treatment as indicated. Fortunately the patient recovered, no neurologic complication occurred except the visus of the right eye that was still 1/oo and the hydrocephalus decreased. Key words : hemophilia - laboratory diagnostics - head injury - hydrocephalus and decreased visus - cryoprecipitat

An increase in mean platelet volume (MPV) as a predictor of mortality in children with sepsis

Sepsis is associated with increased morbidity and mortality in children worldwide, mainly in developing countries. This fatal risk emphasizes the importance of finding accessible and inexpensive parameters to be used as predictors for mortality in children with sepsis. The aim of this study was to determine the role of increased mean platelet volume (MPV) as a predictor for mortality in children with sepsis.  A case control study was applied using medical records of all in-patients aged 1 mo -18 y diagnosed with sepsis at Dr. Sardjito General Hospital, Yogyakarta from January 2015-December 2016. Bivariate and multivariate analyses by Chi-square and logistic regression to evaluate the correlations between increased MPV within the first 24-72 h (ΔMPV>0) and mortality were applied. Eighty-one eligible subjects met the inclusion/exclusion criteria with the mortality was 52%. Chi-square analysis showed significant correlations between increased MPV and mortality (p=0.005). Multivariate analysis showed increased MPV within the first 24-72 h after sepsis diagnosis as a predictor for mortality after controlling for sex and AKI (adjusted OR 3.851; 95% CI:1.354-10.948; p= 0.011). In conclusion, an increase in MPV within the first 24-72 h after diagnosed is an independent predictor for mortality in children with sepsis

Deferoksamin Untuk Pencegahan hemokromatosis pada penderita thalassemia

Thalassemia major is an inherited diiorder of globin synthesis characterized by in effective erythropoiesis, shortened red blood cell survival, and severe anemia. Repeated transfusions are the basis of therapy for this disease. Although such therapy alleviates the anemia and its sequelae, it leads to massive iron deposition to the body tissue or hemochromatosis. These patients undergo progressive deterioration in pancreatic, hepatic and cardiac. function and usually succumb to life-theaterning arrhythmias or intractable heart failure. In the last decade, children with thalassemia major have been treated with an intensive transfusion regimen combined with continuous iron chelation with deferoxamine. Excretion of iron in response to intramuscular deferoxamine, however, is less than that achieved in response to continuous subcutaneous of intravenous infusions. Subcutaneous administration of deferoxamine is nearly (79%90%) as effective as the intravenous route, and appears to be the methode of choice. The recomended dose of deferoxamine was 20.60 mg/kg body weight. Vitamin C supplementation augments excretion of iron in response to deferoxamine in many patients. Treatment with deferoxamine has prove delay cardiac complication, prevent hepatic fibrosis, improve growth hormon secretion and survival time for patients with thalassemia major. Key words: thalassemia, hemochromatosis, deferoxamine, Vit. C, survival tim

Laporan kasus: Dermatitis atopi berat dengan xeroftalmia pada anak

Sumadiono & Hartono - Severe atopic dermatitis with xerophthalmia in children: A case report The management of the atopic dermatitis is not easy and in the severe cases it is a chalenge for the physician. It was reported a 6 year and 3 month old boy with severe atopic dermatitis with erythroderma, secondary infection, marasmic type of severe malnutrition with xerophthalmia, suspected iron defeciency anemia, acute gastroenteritis and miliary tuberculosis. The child had suffered from this disease since he was 3 months old, spreading and becoming worse. The clinical manifestations were redness and black appearance of the skin, excoriation and cast in the skin, some pats of the skin chaping and watery, there was a lacerated wound around his nose. There were many relatives with atopic history in his family tree. The patient had allergy to some medicines (ampicillin and sulfa), and also to many kinds of food. There was eosinophilia in the peripheral blood. The patient had been treated with topical skin medicine, systemic antihistamin/corticosteroid, anti tuberculosis, antibiotics, and local treatment for his eyes, but no improvement. According to the discussion between pediatricians and dermatologists the patient was suffered from severe atopic dermatitis, and was suspected had another disease (geno dermatitis). It is important to avoid drugs that had triggerred allergy before. The limitation of the diet had caused severe malnutrtion. Vitamin A had to be given early. Second generation antihistamine was actually needed to be given early and for several months. It was necessary to do many examinations to establish more exact diagnosis, but the patient died before the examinations were done. Key words : Atopi dermatitis in children - eosinophil - marasmus xerophthalmia - treatmen

Exclusive breastfeeding and risk of atopic dermatitis in high risk infant

Background: WHO recommends exclusive breast-feeding for 6 months becaase it is highly beneficial. It hasbeen proven by a number of studies to be advantageous in preventing various infectious diseases. However,its role in preventing allergic diseases especially atopic dermatitis in infant remains uncertain until recently.Objective: To find out whether high risk infant who did not receive exclusive breast-feeding would have agreater risk to suffer from atopic dermatitis.Method: We conducted a case-control study. Data were obtained from Pediatric Outpatient Clinics andDermatology and Venerology Outpatient Clinics, Dr. Sardjito Hospital Yogyakarta. Case group was highrisk infants with atopic dermatitis, while control group was high risk infants but not having the disease.Statistical analysis used Chi-square and degree of significance was stated as Confidence Interval (CI) of95% for each Odds Ratio (OR). Multivariate analysis was performed by using logistic regression method.Results: The study included 88 subjects with 44 subjects for case and control groupas well Logisticregression showed that not receiving exclusive breast-feeding was statistically significant risk factor toatopic dermatitis in high risk infant {OR 3.72 (95% CI: 1.40-9.90); p 0.01}.Conclusion: High risk infant not receiving exclusive breast-feeding will have greater risk to develop atopicdermatitis.Keywords: exclusive breast-feeding, atopic dermatitis; high risk infants

Immunotherapy and probiotic treatment for allergic rhinitis in children

Background Allergic rhinitis is a global health problem that is increasing in prevalence. Many kinds of therapy have been tried, such as antihistamines, probiotics, and immunotherapy. Immunotherapy may restore the patient’s normal immunity against the specific allergen, while probiotics may modify the natural course of allergy. Objective To evaluate probiotics and immunotherapy for improving clinical symptoms of allergic rhinitis. Methods This randomized controlled trial (RCT) involved 64 patients, aged 3-18 years, and diagnosed with persistent allergic rhinitis in the Department of Child Health, Sardjito General Hospital from April 2016 until May 2017. Patients were randomly allocated into three therapy groups: group A (standard therapy/cetirizine only), group B (standard and probiotic therapy), and group C (standard therapy and immunotherapy). Clinical symptoms of allergic rhinitis including sneezing, rhinorrhea, and itchy nose, were evaluated for 7 weeks and classified as improved or not improved. The significance of the data was analyzed using proportion test. Results Sixty-four patients completed 7 weeks of therapy, 15 subjects in group A, 26 in group B, and 23 in group C. Group C showed significantly more improvement of sneezing and rhinorrhea compared to both group A (Z=5.71; Z=7.57, respectively) and group B (Z=2.82; Z=6.90, respectively). However, itchy nose was not significantly improved in group C compared to group B (Z=0.50), but was significantly improved in group C compared to group A (Z=10.91). Group B had significant improvement of sneezing, rhinorrhea, and itchy nose compared to group A (Z=3.81, Z=2.86, and Z=10.91, respectively). Conclusion The combined standard-immunotherapy group has significantly superior improvement compared to the combined standard-probiotic group and the standard therapy group, in terms of sneezing and rhinorrhea in children with persistent allergic rhinitis

Factors associated with pericardial effusion in pediatric systemic lupus erythematosus

Background Cardiovascular involvement in systemic lupus erythematosus (SLE) has been reported to range from 4-78%. Complications can affect all structures of the heart, including the endocardium, myocardium, pericardium, and valves. Pericarditis is the most common manifestation, with an incidence of 11-54% in SLE patients. Pericardial effusion is often observed in patients with pericarditis, and can be confirmed by echocardiography. Objective To determine factors associated with pericardial effusion in children with SLE. Methods We conducted a restrospective cross-sectional study by reviewing medical records of children with SLE aged less than 18 years who underwent echocardiography at the Dr. Sardjito Hospital. Yogyakarta, from January 2011 to March 2018. Patients with congenital heart disease or incomplete medical records were excluded. A multivariate logistic regression analysis was done to determine factors that independetly associated with pericardial effusion. Results Among 165 children with SLE, 73 fulfilled the inclusion criteria. The prevalence of pericardial effusion was 54.8%. Median age was 13 (range 5-17) years and the female-to-male ratio was 8:1. Hemolytic anemia (OR=4.135; 95%CI 1.039 to 16.453; P=0.044) was significantly associated with pericardial effusion. Conclusion Hemolytic anemia is significantly associated with pericardial effusion in children with SLE

Vaksin Dengue

Dengue hemorrhagic fever remains one of the world\u27s most important cause of morbidity and mortality. Vector control has been proven to be an inadequate preventive measure that a new strategy is needed to alleviate the increasing burden of illness of this disease. Vaccination against dengue has become a promising solution to this problem. Base on antibody dependent pathogenesis, the ideal vaccine should be prevent all of four serotypes, cheap, effective, minimal side effect, genetic and antigenetic stable, and long life protection. There are several types of vaccines currently under investigation, among them are vaccines made by classic attenuation method, attenuation by way of genetical engineering, sub unit vaccines of purified protein and protein made by gen cloning techniques, vaccine using vaccinia virus as vector and DNA vaccine. The development of biomolecular engineering is expected to enable the production of vaccine in large quantity which is economically cheaper. Until recently vaccine produced by attenuation and recombinant are availeble for production, while other vaccine candidates are still under investigation. Keywords: dengue, vaccine, recombinan

THALASSEMIA DI UPF KESEHATAN ANAK RSUP DR. SARDJITO TAHUN 1986 S/D 1992

With the better quality of health care and public sosioeconomic condition, the public concern with genetic disorders (including thalassemia) tends to rise. The aim of this study is to find out the total number of thalassemic patients in the functional care unit for the child health Dr. Sardjito (Central) General Hospital from 1986 to 1992, according to the number of patients per year, the types of thalassemia, sex, age, home, percentage of routine control and clinical signs at the time the diagnosis was made. A study of all patients with thalassemia hospitalized or undergo routine control at functional care unit for child health Dr. Sardjito (Central) General Hospital, from 1986 to 1992 has been done. The data were taken from medical records of patients who were diagnosed as thalassemia. There were 86 patients with thalassemia, with the mean of 10.3 patients per year, and tended to increase in the last two years. Among them 63.95% were male and 36.05% were female. Thalassemia major were 68.60% and beta-HbE thalassemia were 31.40%. The percentage of routine control was still low. Patients who came from Yogyakarta Special Teritory were 52.32%, the other came from 3 nearest city and the rest of them came from other districts of Central Java, particularly from the southern part. Almost of all the patients came with paleness (100%), splenomegaly (93%) pot belly (75%), hepatomegaly (66%) and facies cooley. Clinical signs such as little extremities, lack of activities and prominence of the front upper teeth were seen more apparently by the increase of the patient\u27s age. Key words.: thalassemia, thalassemia major , beta-HbE thalassemi