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Paediatrica Indonesiana

paediatrica-indonesiana
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Published by Ikatan Dokter Anak Indonesia

ISSN : 00309311 EISSN : 2338476X DOI : -

Core Subject : Health,

Health Professions Medicine & Pharmacology

Paediatrica Indonesiana is a medical journal devoted to the health, in a broad sense, affecting fetuses, infants, children, and adolescents, belonged to the Indonesian Pediatric Society. Its publications are directed to pediatricians and other medical practitioners or researchers at all levels of health practice throughout the world.

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Search results for , issue "Vol 53 No 5 (2013): September 2013" : 11 Documents clear

Probiotic therapy on children with allergic rhinitis Franky Luhulima; IPG Karyana; Sumadiono Sumadiono
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

phils in nasal secretions of patients with allergic rhinitis may cause persistent nasal blockage. A common therapy for allergic rhinitis is oral or intranasal corticosteroids. However, corticosteroids carry the risk of disrupting growth and development in children. Probiotic treatment in allergic rhinitis patients works by manipulating the bacterial ecosystem of the digestive tract, stimulating the balance of Th1 and Th2 immune responses.Objective To assess the effects of probiotic supplementation on eosinophil levels in nasal secretions, duration of allergic episodes, and total nasal symptom scores in children aged 2-18 years with allergic rhinitis.Methods A randomized, double-blind, controlled trial was performed on children aged 2 to 18 years who visited Sanglah Hospital, Denpasar, between March to July 2012 due to allergic rhinitis. Fifty-five eligible subjects were involved in the study. Subjects were randomly allocated to receive either standard therapy (antihistamines) and probiotics or standard therapy and placebo for 30 days. Mann-Whitney test was used for statistical non-parametric unpaired samples analysis. P values of <0.05 were considered to be statistically significant.Results Fifty-five subjects with allergic rhinitis were randomized into either the probiotic group (27 subjects) or the placebo group (28 subjects). We found that the median (range) nasal eosinophil percentage reduction before the study compared to after 30 days of treatment was higher in the probiotic group than in the placebo group (34 (15-65) vs 6 (0-24) %, respectively, P<0.0001). Median (range) duration of allergic rhinitis episode in the probiotic group was shorter compared to the placebo group (48 (0-96) hours vs 72 (6-168) hours, respectively; P<0.0001). The median (range) total nasal symptom score was also lower in the probiotic group compared to the placebo group (2 (0-3) vs 5 (1-6), respectively; P<0.0001).Conclusion Probiotic supplementation reduces the percentage of nasal eosinophils, duration of allergic rhinitis episode, and total nasal symptoms.

Cotinine and interferon-gamma levels in pre-school children exposed to household tobacco smoke Lina Kalalo; Diana Takumansang-Sondakh; Audrey Wahani
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Environmental tobacco smoke has been consistently linked to negative health outcomes, especially in children, including an increased susceptibility to infections. Cigarette smoking has a depressive effect on interferon-Î³ (IFN-Î³). Serum cotinine is a marker of exposure to smoke.Objective To determine the association between serum cotinine and interferon-Î³ (IFN-Î³) levels in children with household tobacco smoke exposure.Methods We conducted a cross-sectional study at the Tumumpa and Singkil Districts of Manado, Indonesia, from February to May 2012. Subjects were collected by consecutively sampling of healthy children aged 1-3 years who came to the integrated health posts. Seventy-four children were recruited and consisted of two groups of 37 subjects each, the tobacco smoke exposure group and the non-tobacco smoke exposure group. Blood specimens were collected from all subjects for laboratory blood tests of cotinine and IFN-Î³ levels. Results were analyzed by T-test and Pearsonâ€™s correlation analysis with a P<0.05 is considered as statistically significant.Results There was no significant correlation between serum cotinine and interferon-Î³ levels in the tobacco smoke exposure group. However, the interferon-Î³ level in the tobacco smoke exposure group was significantly lower than that of the non-tobacco smoke exposure group (P<0.0001).Conclusion Cotinine is not related to the interferon-Î³ level in children exposed to tobacco smoke, however, the interferon-Î³ level in children with tobacco smoke exposure is lower than in the non-tobacco smoke exposure group.

Effect of length of albendazole treatment against Trichuris trichiura infection Aridamuriany D Lubis; Syahril Pasaribu; Muhammad Ali; Munar Lubis
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Trichuris trichiura is one of the most common soil-transmitted helminth that infects school-aged children. A single dose of albendazole has been shown to have wide variations in cure and egg reduction rates. Some studies have suggested that repeated doses of albendazole might increase its effectiveness.Objective To compare the anti-trichuriasis effect of 400 mg albendazole taken daily for five consecutive days vs. seven consecutive days.Methods A randomized open clinical trial was conducted from August to September 2009 on elementary school children at Jaring Halus in the North Sumatera Province. Stool specimens were collected before treatment and on days 7, 14, 21, and 28 after initiation of treatment, and examined by the Kato Katz method. Subjects were randomized into two groups. Group I received 400 mg albendazole daily for five consecutive days and Group II received 400 mg albendazole daily for seven consecutive days. Cure rates and egg reduction rates were compared using Chi-square and T-tests, respectively.Results One hundred twenty-one children were enrolled, consisted of 61 children in Group I and 60 in Group II. For the first week after treatment ended, the cure rates in Group II was higher (86.7%) than in the Group I (39.3%) (P=0.001), as well as in the second week after treatment ended (88.3% vs 68.9%, P=0.017). However, after 3rd and 4th weeks, the cure rates were no longer significantly different. Egg reduction rate was also statistically higher in the Group II [20.3 (SD 23.77) %] compared to Group I [6.6 (SD 11.30) %].Conclusions Albendazole for seven consecutive days is more effective in curing Trichuris trichiura infection in the 1st and 2nd weeks after treatment compared to that of five consecutive days, as well as in egg reduction rate, but the length of treatment does not influence the cure rate after the 3rd and 4th weeks.

Interleukin-6 and insulin resistance in obese adolescents Raynald Takumansang; Sarah M. Warouw; Hesti Lestari
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Obesity has become a rapidly growing epidemic worldwide, increasing the risk of morbidity and mortality in adolescents. Obesity is due to an expansion of adipose tissue mass, which is an important source of cytokines and contributes to an increase in pro-inflammatory cytokines, such as interleukin-6 (IL-6). Interleukin-6 is significantly increased in obesity and may lead to a state of insulin resistance.Objective To assess for a correlation between IL-6 levels and insulin resistance in obese adolescentsMethods We conducted a cross-sectional study from January to April 2012 in Manado, North Sulawesi. Subjects were either obese or normal body mass index (BMI) teens aged 13-18 years. Data collected were anthropometric status, BMI, and blood specimens for fasting plasma glucose levels, fasting insulin levels, and IL-6 levels. Insulin resistance was expressed as homeostatic model assessment of insulin resistance (HOMA-IR) level >2.77. Data was analyzed by Pearsonâ€™s correlation and linear regression tests to assess for a possible correlation between IL-6 levels and insulin resistance.Results The mean BMI in the obese group was 31.21 (SD 3.61) kg/m2 while the mean BMI in the normal group was 19.52 (SD 2.38) kg/m2. There was no significant association between IL-6 and the occurrence of insulin resistance (P=0.309). The log regression coefficient value of IL-6 was negative (b = -0.329).Conclusion There is no correlation between IL-6 levels and incidence of insulin resistance in obese adolescents.

Transcatheter closure of tubular type patent ductus arteriosus using AmplatzerÂ® ductal occluder II: a case report Mulyadi M Djer; Nikmah Salamia Idris; Angelina Angelina
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Patent ductus arteriosus (PDA) is a common congenital heart disease, accounting for 5-10% of all congenital heart diseases. The incidence of PDA is even higher in preterm neonates, ranging from 20-60%.1-4 Closure of PDA is indicated in all cases, except for duct-dependent congenital heart diseases or PDA with Eisenmenger syndrome.1,5,6 In small asymptomatic PDAs, closure is indicated to prevent the risk of complications, such as endarteritis, endocarditis, aneurysm of ductus arteriosus, or congestive heart failure.1,2,7In recent years, interventional cardiology has become a gold standard therapy for the majority of PDA cases beyond neonatal age. Since its introduction in 1967, many devices and methods have been developed to allow transcatheter closure of virtually all PDAs, regardless of size or configuration. Nevertheless, the tubular shape (type C) PDA, which has the highest residual shunt rate, still poses a great challenge for the interventionist.8-10 The second generation of AmplatzerÂ® device occluders (ADO II), released in 2007, has been suggested to be effective in closing tubular PDAs.10 The purpose of this study was to report the initial clinical experience using ADO II to close a tubular type PDA in Indonesia.

Insulin therapy for hyperglycemia in critically ill patients Julianti Julianti; Silvia Triratna; Aditiawati Aditiawati; Irfanuddin Irfanuddin
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Hyperglycemia in critically ill patients is associated with higher mortality. Insulin therapy may improve outcomes, not only by preventing deleterious effects of hyperglycemia, but by improving the molecular dynamics in organ dysfunction.Objectives To assess the effects of insulin therapy on critically ill patients in an intensive care unit (ICU) setting and the risk of hypoglycemia.Methods An open-label, clinical trial was conducted in the Pediatric Intensive Care Unit (PICU) of Dr. Moh. Hoesin Hospital, Palembang, from November 2011 to March 2012. Subjects were consecutively assigned to receive either regular insulin at a dose of 0.05 U/kg/h if the blood glucose level reached >200 mg%, or standard therapy (control group). Blood glucose levels were measured hourly until they reached 80-110 mg%. Dose adjustments were made when the blood glucose level reached 145 mg%, by reducing the insulin dose to 0.025 U/kg/h. Outcomes of therapy were measured by Pediatric Logistic Organ Dysfunction (PELOD) score improvement, mortality rate and the occurrence of hypoglycemia.Results Forty subjects were enrolled in this study, with 20 subjects assigned to the insulin therapy group and 20 subjects to the standard therapy group. Two subjects, one from each group, were not included in the final analysis due to their deaths within 24 hours. There was no significant difference in distribution of PELOD scores before intervention between the groups (OR=0.5; 95%CI 0.1 to 1.9, P=0.32). However, after intervention, the PELOD scores was significantly lower in insulin therapy group compared to control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). In the insulin group after intervention, fewer subjects had scores >20.5 and more subjects had scores â‰¤20.5, indicated a lower risk of organ dysfunction. There was also a significantly lower mortality rate in the insulin group compared to the control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). None of the subjects suffered hypoglycemia.Conclusion Insulin is beneficial in improving organ dysfunction and decreasing mortality for critically ill patients.

Plasma homocysteine and blood pressure in small for gestational age children Irene Melinda Louis; Adrian Umboh
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Homocysteine is associated with endothelial damage and hypertension. Increased plasma homocysteine levels are often accompanied by cardiovascular impairment, including hypertension. Small for gestational age children have been found to have morbidity and mortality in cardiovascular diseases.Objective To assess for a possible association between homocysteine level and blood pressure in small for gestational age children.Methods This observational study was undertaken from December 2011 to April 2012 in Prof. Dr. R. D. Kandou Hospital, Manado, North Sulawesi, on children who were born small for gestational age in year 2004-2005. Data was analyzed by T-test to compare homocysteine levels in small for gestational age and normal birth weight children. Regression analysis and simple coefficient test were used to assess for an association between homocysteine levels and blood pressure in children who were small for gestational age at birth.Results The mean homocysteine level in small for gestational age children was significantly higher than that of normal birth weight children (P<0.001). We observed no correlation between homocysteine level and systolic blood pressure in the small for gestational age group (r=0.151, P=0.189). However, there was a weak correlation between homocysteine level and diastolic blood pressure in the small for gestational age group (r=0.237, P=0.049).Conclusion Children who were small for gestational age at birth have significantly higher mean homocysteine level than that of normal birth weight children. Higher homocysteine levels are associated with higher diastolic blood pressure in children who were small for gestational age at birth.

McIsaac criteria for diagnosis of acute group-A Î²-hemolytic streptococcal pharyngitis Imanuel Y. Malino; Dwi Lingga Utama; Yati Soenarto
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background The early use of antibiotics for acute upper respiratory infections is controversial because most of these infections are caused by viruses. A strategy is needed to correctly identify the causitive agents of acute pharyngitis, so that antibiotics can be prescribed appropriately.Objective To assess McIsaac criteria for diagnosing acute group-A Î²-hemolytic streptococcal (GABHS) pharyngitis in children.Methods This diagnostic study was conducted from August 2011 to February 2012, to compare clinical criteria of McIsaac to throat swab culture results as the gold standard for diagnosis. Subjects were children aged 3-14 years who visited the pediatric outpatient clinic or emergency ward at Sanglah Hospital and the pediatric outpatient clinic at Wangaya Hospital.Results There were 550 cases of acute pharyngitis during the study period, with 313 patients aged 3-14 years and 199 patients excluded due to a history of taking antibiotics in the two weeks prior to the hospital visit. Hence, 114 subjects were eligible for the study. GABHS prevalence in this study was 7.9%. McIsaacâ€™s area under the curve (AUC) from receiver operating characteristic (ROC) curve was 78.1%(95%CI 60.3 to 96%, P= 0.005). A McIsaac score â‰¥4 had a 66.7% (95%CI 49 to 97%) sensitivity, 87.6% (95% CI 81 to 94%) specificity, 31.6% (95 %CI 11 to 52%) positive predictive value (PPV), 96.8% (95%CI 93 to 100%) negative predictive value (NPV), 86.0% accuracy, 5.4 (95% CI 2.7 to 10.7) positive likelihood ratio (LR+) and 0.4 (95% CI 0.2 to 0.9) negative likelihood ratio (LR-).Conclusion A McIsaac criteria total score of <4 is favorable for excluding a diagnosis of GABHS pharyngitis. A McIsaac total criteria score of â‰¥4 requires further examination to confirm a diagnosis of GABHS pharyngitis.

The use of topical zinc in tuberculin test Anisa Rahmadhany; Darmawan Budi Setyanto; Partini Pudjiastuti Trihono
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

with under-diagnosis or over-diagnosis commonly occurring. The tuberculin test as a supporting examination for tuberculosis infection has a false negative value rate of 10-25%. Also, a majority of children with tuberculosis have lower plasma zinc levels than healthy children. Zinc deficiency may impair the immune response, leading to more false negative skin-test results.Objective To evaluate the effectiveness of topical zinc for augmenting the diameter of tuberculin induration in children with tuberculosis.Methods This unblinded, clinical trial was performed from October to December 2012 in subjects matched with themselves. Subjects were children with tuberculosis aged 2-18 years at the Department of Child Health at Cipto Mangunkusumo Hospital and Persahabatan Hospital. Every subject was injected tuberculin in volar region of left and right arm. Test sites then were covered with topical zinc cream on the right arm and placebo cream on the left arm. Indurations were measured after 72 hours. The difference of tuberculin diameter of 3 mm was considered as clinically significant. Data analysis was performed with Wilcoxon signed rank test.Results There were 47 subjects in this study. The majority of subjects were well-nourished (53%). Subjectsâ€™ median treatment duration was < 6 months, median age was 72 months and 47% of subjects were under the age of five years. Sixteen subjects had a median 1 mm difference in tuberculin induration diameter between the zinc arm and placebo arm (P<0.001), but this was clinically insignificant. Twenty-two subjects (43%) had Koch reaction after zinc cream application, but the placebo cream did not cause Koch reaction.Conclusion Application of topical zinc does not increase tuberculin induration compared to placebo.

Phototherapy for neonatal jaundice at distances of 20 cm vs 40 cm Winra Pratita; Supriatmo Supriatmo; Guslihan Dasa Tjipta
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Neonatal jaundice is one of the most common problems in newborns. Phototherapy is the most widespread treatment for lowering bilirubin concentration in neonates. Phototherapy may be more effective if the light source is placed closer to the neonate.Objective To compare the effectiveness of phototherapy with a 20 cm distance between the light source and the neonate vs a 40 cm distance for decreasing serum bilirubin concentrationMethods An open, randomized, controlled trial was conducted at H. Adam Malik and Pirngadi Hospitals in Medan from August 2009 to March 2010. Subjects were divided into two groups. One group (n=30) received phototherapy at a distance of 20 cm between the light source and the neonate, while the other group (n=30) received phototherapy at a distance of 40 cm. The inclusion criteria in the study were newborns presenting with neonatal jaundice in their first week of life. Serum bilirubin levels were measured at baseline, as well as after 12 hours and 24 hours of phototherapy.Results The mean total bilirubin levels of the 20 cm and 40 cm groups at baseline were 18.8 (SD 1.73) mg/dL and 17.7 (SD 1.46) mg/dL, respectively, not significantly different. After 24 hours of phototherapy, the mean decreases in total serum bilirubin levels of the 20 cm and 40 cm groups were significantly different with 7.6 (SD 1.01) mg/dL and 2.0 (SD 0.83) mg/dL, respectively, (P<0.05).Conclusion Phototherapy with a 20 cm distance between the light source and the neonate is more effective than a 40 cm distance for decreasing bilirubin levels at 24 hours in newborns with hyperbilirubinemia.

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