Faktor Risiko Usia dan Gejala Klinis terhadap Status Gizi Anak Penyakit Jantung Bawaan di RSUP H. Adam Malik Medan Tahun 2020-2021

Pendahuluan. Penyakit jantung bawaan (PJB) merupakan kelainan baik pada struktur jantung atau pembuluh darah besar maupun fungsi jantung yang didapat sejak masih berada dalam kandungan. Beberapa faktor risiko diduga dapat mempengaruhi status gizi anak dengan PJB. Tujuan. Menganalisis faktor risiko usia dan gejala klinis terhadap status gizi anak penyakit jantung bawaan. Metode. Penelitian observasional yang bersifat analitik dengan desain cross sectional study. Teknik pengambilan sampel dilakukan dengan cara consecutive sampling. Pengumpulan data dari rekam medis dan dianalisis dengan aplikasi SPSS, baik uji bivariat (Chi-Square test) dan multivariat (Binary logistic regression). Hasil. Terdapat 185 anak dengan PJB. Mayoritas berjenis kelamin laki-laki (94 orang (50,8%)). VSD merupakan jenis PJB terbanyak (80 orang (43,2%)). Mayoritas berusia 0-5 tahun (129 orang (69,7%)). Mayoritas berstatus malnutrisi (98 orang (53%)). Hasil analisis bivariat, tidak ada hubungan usia terhadap status gizi anak dengan PJB (P=0,892) sedangkan gejala klinis berhubungan terhadap status gizi anak dengan PJB (P=0,000). Hasil analisis multivariat, usia tidak dapat dinilai dikarenakan nilai P=0,892 (P>0,25) sedangkan gejala klinis dapat dinilai dikarenakan nilai P=0,000 (P˂0,25) serta berpengaruh signifikan terhadap status gizi anak dengan PJB (P=0,000 dan AOR=3,260 (95% CI=2,128-4,994)). Kesimpulan. Gejala klinis berhubungan serta berpengaruh signifikan terhadap status gizi anak dengan PJB. Kata kunci: Anak, Penyakit Jantung Bawaan, Status Gizi   Background. Congenital Heart Disease (CHD) is an abnormality in the structure of the heart or large blood vessels as well as heart function that is acquired while still in the womb. Several risk factors are suspected to affect the nutritional status of children with CHD. Aim. Analyzing the risk factors of age and clinical symptoms on the nutritional status of children with congenital heart disease. Methods. An analytic observational study with a cross sectional study design. The sampling technique in this study was carried out by consecutive sampling. Data collection from medical records and analyzed by SPSS application, both bivariate test (Chi-Square test) and multivariate (Binary logistic regression). Results. There are 185 children with CHD. The majority were male (94 people (50.8%)). VSD was the most common type of CHD (80 people (43.2%)). The majority were aged 0-5 years (129 people (69.7%)). The majority were malnourished (98 people (53%)). The results of bivariate analysis showed that there was no relationship between age and the nutritional status of children with CHD (P=0.892) while clinical symptoms were related to the nutritional status of children with CHD (P=0.000). The results of multivariate analysis showed that clinical symptoms could be assessed due to the value of P=0.000 (P˂0.25) and had a significant effect on the nutritional status of children with CHD (P=0.000 and AOR=3,260 (95% CI=2,128-4,994)). Conclusion. Clinical symptoms are associated and have a significant effect on the nutritional status of children with CHD.   Keywords: Child, Congenital Heart Disease, Nutritional Statu

Gambaran Pengetahuan Ibu Hamil Tentang Hiperemesis Gravidarum pada Trimester I Kehamilan

Background: Nausea and vomit are problems that often occur in the first trimester of pregnancy, and this can cause problems for pregnant women. Many people still have the perception that this is a normal occurrence, leading pregnant women to avoid medical examinations, resulting in potential side effects. This relates to the knowledge. Pregnant women with poor knowledge can lead to complications during pregnancy, while those with good knowledge will prevent complications. Objective: To describe pregnant women’s knowledge about hyperemesis gravidarum in the first trimester of pregnancy based on age, gravida, and academic. Methods: This research is an observational descriptive study with a cross-sectional research design, employing consecutive sampling method. Data were collected using primary data sources derived from questionnaire responses. Results: Based on data from 100 respondents, 28 people (28%) have good knowledge. 27 people (27%) have moderate knowledge. 45 people (45%) have poor knowledge. Conclusion: Most of pregnant women in this research belonged to the age group of 19-34 years, with primigravida and majority have poor knowledge. Keyword: Hyperemesis gravidarum, knowledge, pregnant women   Latar Belakang: Mual dan muntah merupakan masalah yang sering terjadi pada trimester pertama kehamilan dan hal ini dapat menimbulkan masalah pada ibu hamil. Masih banyak masyarakat yang memiliki pandangan bahwa hal tersebut normal terjadi, sehingga ibu hamil tidak melakukan pemeriksaan dan akan menimbulkan efek samping. Hal ini berkaitan dengan pengetahuan yang dimiliki oleh ibu hamil. Ibu hamil yang memiliki pengetahuan yang kurang terhadap hiperemesis gravidarum menyebabkan terjadinya komplikasi pada ibu hamil, sedangkan ibu hamil dengan pengetahuan yang baik akan mencegah terjadinya komplikasi. Tujuan: Untuk mengetahui tingkat pengetahuan ibu hamil terhadap hiperemesis gravidarum pada trimester I kehamilan berdasarkan usia, pendidikan terakhir dan gravida. Metode: Penelitian ini adalah penelitian deskriptif observasional dengan desain penelitian cross sectional. Pengambilan sampel dengan consecutive sampling. Data yang diambil menggunakan sumber data primer yang berasal dari pengisian kuesioner. Hasil: Berdasarkan data yang diperoleh dari 100 responden terdapat 28 orang (28%) memiliki pengetahuan baik. 27 orang (27%) memiliki pengetahuan cukup. 45 orang (45%) memiliki pengetahuan kurang. Kesimpulan: Mayoritas ibu hamil pada penelitian ini merupakan kelompok usia 19-34 tahun, dengan primigravida, dan mayoritas memiliki pengetahuan yang kurang. Kata Kunci: Hiperemesis gravidarum, ibu hamil, pengetahua

Effect of intra-arterial heparin flushing (IAHF) to prestin and vascular endothelial growth factor (VEGF) level in hearing loss patients

Background: According to the World Health Organization (WHO), hearing loss is the fourth largest disability globally, affecting an estimated 466 million people in 2018. In Indonesia, the prevalence of hearing loss was estimated at 16.8% in 2016. Intra-Arterial Heparin Flushing (IAHF) is an endovascular technique that uses heparin to promote reperfusion and increases Vascular Endothelial Growth Factor (VEGF) expression. VEGF is a polypeptide angiogenesis factor present in the nervous system, which functions as a neurotrophic and neuroprotective. Meanwhile, prestin is a protein of outer ear hair cells that shows early signs of hearing loss through increased levels in cases of ear hair cell damage. Objective: This study aims to evaluate the effect of IAHF on prestin and VEGF levels in hearing-impaired patients. Methods: The design is experimental with Pre-Post Test One-Group Only. A total of 22 patients with hearing loss were measured for prestin and VEGF before and 4 hours after the IAHF procedure. Results: The results of the Wilcoxon test showed no significant differences in prestin level (p=0.658) and VEGF level (p=0.291) before and after the IAHF procedure. The mean showed an insignificant decrease in prestin level before and after the IAHF procedure with values of 1,185+1,229 pg/mL and 1,096+1,183 pg/mL, respectively. However, the VEGF level insignificantly increased before and after the procedure with values of 484.83+274.6 pg/mL and 498.79+257.7 pg/mL, respectively. Conclusion: There were no significant differences in prestin and VEGF levels before and after the IAHF procedure. However, there was a decrease in the prestin level and an increase in the VEGF level

Malaria in Indonesia: current treatment approaches, future strategies, and potential herbal interventions

Malaria remains a significant public health challenge in Indonesia, with varying prevalence across regions, particularly in eastern provinces like Papua and West Papua. This parasitic disease, transmitted by Plasmodium-infected Anopheles mosquitoes, continues to burden affected populations. Contemporary treatment approaches predominantly rely on Artemisinin-based Combination Therapy (ACT). However, the emergence of drug resistance, coupled with environmental and demographic factors, presents ongoing challenges. This paper explores current malaria treatment strategies in Indonesia, emphasizing the importance of vigilance in the face of drug resistance and the need for innovative approaches. Additionally, it discusses the potential of herbal interventions, drawing from the rich traditional knowledge of medicinal plants in Indonesia. Secondary metabolites found in herbs, including flavonoids, terpenoids, and alkaloids, show promise as antimalarial agents. As Indonesia and the global community strive to combat malaria, research, surveillance, and healthcare infrastructure development must remain at the forefront of strategies. Despite the complex nature of malaria control, continued dedication and collaboration offer hope for reducing the disease’s impact and progressing towards its eventual elimination. Graphical abstract

Obesity and left ventricular mass in children

Background Obesity has negative effects on cardiac function during growth leading to increased heart size and mass, as a result of higher stroke volume and cardiac output. Objective To assess for a relationship between obesity and left ventricular mass (LVM) in children, as well as to assess for a correlation between the duration of obesity and LVM. Methods This cross-sectional study was conducted from October 2011 until February 2012 in Medan and included 30 obese and 30 normal weight children, aged 6 to 13 years. All subjects underwent complete echocardiography examinations to assess LVM and other left ventricular parameters. The Devereux formula was used to measure LVM. Results During the study, 65 children underwent echocardiography, but 5 were subsequently excluded. The left ventricular dimensions in the obese group were significantly higher compared to normal weight group with regards to interventricular septum at end diastole (IVSd), interventricular septum at end systole (IVSS), left ventricular internal diameter at end diastole (LVIDd), left ventricular internal diameter at end systole (LVIDs), left ventricular posterior wall thickness at end diastole (LVPWd), left ventricular mass (LVM), and left ventricular mass index (LVMI) (P=0.0001). Duration of obesity and LVM had a moderate, positive correlation (r=0.407). Conclusion There is significantly higher LVM in the obese group than in the normal weight group. The duration of obesity had a moderate, positive correlation to LVM

Oral contraceptive use and conotruncal congenital heart disease

Background Congenital heart disease (CHD) represents some of the more prevalent malformations among live births and remains the leading cause of death from congenital malformations. Conotruncal anomalies comprise a diverse group of CHD involving the outflow tracts of the heart and the great vessels. Oral contraceptive exposure before pregnancy may be one of the risk factors for conotruncal CHD. Objective To evaluate the effect of oral contraceptive use before pregnancy on the risk of conotruncal CHD in children. Methods A case-control study was conducted from July 2010 until July 2011 in Haji Adam Malik Hospital, Medan. Subjects with CHD were divided into two groups: conotruncal CHD as the case group and non-conotruncal CHD as the control group. Both groups had mothers with and without histories of oral contraceptive use before pregnancy. Parents were interviewed using questionnaires. Statistical analyses were performed using Chi-square test, student’s T-test, and Mann Whitney test. Results A total of 80 subjects were eligible, with 40 subjects in each group. The percentages of subjects whose mothers used oral contraceptives were 62% of the conotruncal CHD group and 60% of the non-conotruncal CHD group (OR 0.82; 95%CI 0.33 to 1.98). The mean duration of maternal oral contraceptive use before pregnancy was 19.1 months for the case group and 18.8 months for the control group (P=0.87). Conclusion In children with CHD, maternal oral contraceptive use before pregnancy does not appear to increase the risk of conotruncal CHD

Correlation between hemoglobin level and left ventricular systolic functions and dimensions in children with chronic severe anemia

Background Chronic severe anemia is a connnon disease. Cardiac output may increase when the hemoglobin (Hb) level decreases to < 7 g/dL for 3 months or more. Alteration of left ventricular (LV) function occurs frequently in children 'With chronic severe anemia, in the {onn of concentric LV hypertrophy, LV dilatation with or v.ithout LV hypertrophy, or systolic dysfunction.  Objective To examine the correlation between Hb level and alteration of LV systolic function in children with chronic severe anemia.  Methods We conducted a cross-sectional study in Adam Malik Hospital from October to December 2009. Subjects were chronic severely anemic children. Left ventricular systolic function (ejection fraction/EF, fractional shortening/FS) and dimensions (left ventricular end diastolic diameter/LVEDD and left ventricular end systolic diameter/LVESD) were measured using Hitachi EUB 5500 echocardiography unit. Univariate analysis  and Pearson correlation were performed. Results Thirty children were enrolled in the study. The mean of age was 113.5 months (SD 53.24). Hb values ranged from 2.1 to 6.9 g/dL with mean value of 4.6 g/dL (SD 1.44). Mean duration of anemia was 3.9 months (SD 0.70). Chronic severe anemia was not associated \\lith decreased LV systolic function [EF 62.2% (SD 9.16), r =0.296, P=0.112; FS 33.8% (SD 7.26), r =0.115, P=0.545], nor LV dimension changes [LVEDD 40.2 mm (SD 6.85), r = -0.192, P=0.308; LVESD 26.2 mm (SD 4.98), r=-0.266, P=0.156].  Conclusion There was no correlation between Hb level in chronically anemic children and changes in LV systolic function or dimension

Consanguinity and congenital heart disease in offspring

Background Congenital heart disease (CHD) is a common congenital abnormality in children. Consanguineous marriage has been identified as a risk factor of  CHD. There was an autosomal recessive pattern of inheritance seen in children with some forms of congenital heart disease. Objective To assess the possible association between consanguineous marriage and congenital heart disease incidence in the offspring. Methods A case-control study was conducted from March to May 2016 on pediatric patients at H. Adam Malik General Hospital, Medan. Subjects were allocated into two groups, 100 children with CHD in the case group, and the rest in the control group. Data were analyzed using Chi-square and logistic regression tests. In the present study, P value less than 0.05 was considered statistically significant. Results In the case group, 14 patients (14%) were born of consanguineous marriages. In the control group, only 5 patients (5%) were born of consanguineous marriages. There was a significant association between consanguineous marriage and CHD (OR 1.551; 95%CI 1.138 to 2.113). Based on the result of multivariate analysis, consanguineous marriage was a risk factor for CHD in offspring (Wald=4.525; P=0.033). Conclusion  Consanguineous marriage is a risk factor for CHD in offspring

Effect of intra-arterial heparin flushing (IAHF) to prestin and vascular endothelial growth factor (VEGF) level in hearing loss patients

Background: According to the World Health Organization (WHO), hearing loss is the fourth largest disability globally, affecting an estimated 466 million people in 2018. In Indonesia, the prevalence of hearing loss was estimated at 16.8% in 2016. Intra-Arterial Heparin Flushing (IAHF) is an endovascular technique that uses heparin to promote reperfusion and increases Vascular Endothelial Growth Factor (VEGF) expression. VEGF is a polypeptide angiogenesis factor present in the nervous system, which functions as a neurotrophic and neuroprotective. Meanwhile, prestin is a protein of outer ear hair cells that shows early signs of hearing loss through increased levels in cases of ear hair cell damage. Objective: This study aims to evaluate the effect of IAHF on prestin and VEGF levels in hearing-impaired patients. Methods: The design is experimental with Pre-Post Test One-Group Only. A total of 22 patients with hearing loss were measured for prestin and VEGF before and 4 hours after the IAHF procedure. Results: The results of the Wilcoxon test showed no significant differences in prestin level (p=0.658) and VEGF level (p=0.291) before and after the IAHF procedure. The mean showed an insignificant decrease in prestin level before and after the IAHF procedure with values of 1,185+1,229 pg/mL and 1,096+1,183 pg/mL, respectively. However, the VEGF level insignificantly increased before and after the procedure with values of 484.83+274.6 pg/mL and 498.79+257.7 pg/mL, respectively. Conclusion: There were no significant differences in prestin and VEGF levels before and after the IAHF procedure. However, there was a decrease in the prestin level and an increase in the VEGF level