Background Type 1 diabetes mellitus (T1DM) is an organ-specific autoimmune disease characterized by T cell-mediated destruction of pancreatic islets. The genetic factors involved consist of at least five vulnerability genes:  HLA, INS, CTLA-4, PTPN22, and IL2RA/CD25. Objective To investigate for associations of PTPN22-1123 G>C SNP and CTLA-4 +49A/G polymorphisms with T1DM. Methods Case and control groups underwent CTLA-4 +49A/G gene examination from June to December 2017, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Results The study population consisted of 30 T1DM patients and 30 healthy subjects with no family history of diabetes or autoimmune diseases. With regards to the PTPN22-1123 G>C SNP, significantly more subjects with T1DM had the GC genotype than the GG genotype (OR 7.64; 95%CI 1.48 to 39.29; P=0.007). For the CTLA-4 +49A/G polymorphism, although the total number of G alleles in the case group was more than that  of  the control group  (OR 2.286; 95%CI 0.804 to 6.945; P=0.118), there were no significant relationships between the frequency of G alleles (P=0.248) and genotypes GG or AG (P=0.293) with the incidence of T1DM. However, the PTPN22-1123 G>C SNP had a significantly positive association with T1DM, and may be considered as a risk factor for T1DM. In contrast, the CTLA-4 +49A/G polymorphism was not recognized as a risk susceptibility factor for T1DM. Conclusion These study confirms an association between PTPN22-1123 G>C SNP and T1DM, but no significant association between CTLA-4 +49A/G polymorphism and T1DM.

Background Obesity is a worldwide problem and is associated

Beberapa tahun terakhir, awitan pubertas dan menarche terjadi pada usia yang semakin dini pada remaja di berbagai negara termasuk Indonesia. Prevalensi obesitas pada anak dan remaja di Indonesia pun cenderung meningkat. Beberapa studi menunjukkan bahwa peningkatan Indeks Massa Tubuh berpengaruh terhadap terjadinya pubertas dini yang merupakan faktor resiko berbagai penyakit.Tujuanpenelitian ini untuk mengetahui hubungan usia menarche dengan Indeks Massa Tubuh pada remaja di Palembang.Penelitian ini adalah  studi observasional analitik dengan desain cross sectional. Sampel penelitian adalah siswi di 4 SD dan 4 SMP di Palembang yang dipilih melalui stratified random sampling. Hasil penelitian menunjukkan  sebanyak 388 responden memenuhi kriteria inklusi. Data usia menarche dan Indeks Massa Tubuh yang didapat melalui kuesioner dan pengukuran antropometri dianalisis menggunakan uji Chi-square.Dari 388 responden, sebanyak 49,5% mengalami menarche pada usia yang lebih awal dibanding rerata yaitu 12,36 tahun dan sekitar 20,1% berstatus gizi berlebih. Usia menarchererataresponden yang berstatus gizi berlebih lebih muda dibanding kelompok status gizi normal dan kurang. Hasil analisis menggunakan uji Chi-square menunjukkan bahwa terdapat hubungan yang sangat bermakna antara usia menarche dengan Indeks Massa tubuh (p=0,000).Kesimpulan penelitian ini menunjukkan Terdapat hubungan yang bermakna antara usia menarche dan Indeks Massa Tubuh. Pengawasan ketat terhadap Indeks Massa Tubuh siswi sekolah dasar dan menengah diperlukan untuk mencegah terjadinya pubertas dini.

Latar belakang. Obesitas dengan riwayat orang tua diabetes mellitus (DM) tipe 2 berhubungan dengan gangguan toleransi glukosa, dislipidemia, dan DM. Toleransi glukosa terganggu (TGT) merupakan pertanda awal terjadinya DM tipe 2. Hemoglobin A1c (HbA1c) telah muncul menjadi alat diagnostik untuk mengidentifikasi DM dan subjek yang berisiko menderita DM. Rekomendasi ini didasarkan pada data dari orang dewasa yang menunjukkan hubungan antara HbA1c dengan terjadinya DM di kemudian hari. Penelitian yang khusus ditujukan pada populasi anak dan remaja masih sedikit. Tujuan. Mengetahui penggunaan dan titik potong optimal pemeriksaan HbA1c dalam mendiagnosis gangguan toleransi glukosa pada anak dan remaja obesitas dengan faktor risiko dibandingkan dengan tes toleransi glukosa oral (TTGO). Accuracy in HbA1c Examination for Detecting Impaired Glucose Tolerance in Obese Children and Adolescents with History of Parents with Type 2 DMAbdi Wijaya,* Aditiawati,* Irsan Saleh** Background. Childhood obesity with parental history of type 2 Diabetes Mellitus (DM) is associated with an increased likelihood for having impaired glucose tolerance, dyslipidemia, and DM. Hemoglobin A1c (HbA1c) has emerged as a recommended diagnostic tool for identifying type 2 DM among subjects who are at risk for the disease. This recommendation is based on data in adults showing the relationship between HbA1c with future development of DM. However, there are lacking studies of this correlation among pediatric population. Objective. The aim of the study was to evaluate HbA1c as a test for impaired glucose tolerance in obese children and adolescents with risk factor and identify the optimal HbA1c threshold (optimal cut of point). Methods. We studied 40 obese children and adolescents (BMI according WHO 2008 Z score +2 SD for age and gender) age 10-15 years with parental history of type 2 Diabetes DM in Palembang. All subjects underwent HbA1c and oral glucose tolerance test (OGTT). Results. Two out of 40 subjects had impaired glucose tolerance. Based on the receiver operating characteristic curve, the optimal cut point of HbA1c in relation to impaired glucose tolerance diagnosed by OGTT was 5.55%, which yield sensitivity of 67% and specificity of 20%, with area under the receiver operating characteristic curve of 79.3% (95% CI 45.7%-100%). Conclusions. HbA1c value of 5.55% should be used as a screening tool to identify impaired glucose tolerance in obese children and adolescents with risk factor. Sari Pediatri 2015;17(1):17-20.

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 ≤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.

Background: Disorders of sex development (DSD) is a state of atypical genitals which raises doubts in assigning gender to the newborns. To date, there are no studies regarding DSD cases in Palembang. This study was aimed to describe the clinical profile of DSD patients at Dr. Mohammad Hoesin Hospital (RSMH), a public general hospital in the center of Palembang. Methods: This was an observational descriptive study using medical records of 151 DSD patients at the RSMH. Age, sex, clinical findings, family history, and consanguineous marriage were investigated. Results: Among the study patients, 61% were first evaluated during their childhood year. Most (84.4%)

Background Childhood obesity is associated with an increasedlikelihood for having impaired glucose tolerance, dyslipidemia,and diabetes. Hemoglobin Ale (HbAl c) h as emerged as arecommended diagnostic tool for identifying diabetes and personsat risk for the disease. This recommendation was based on datain adults, showing the relationship between HbAl C and thefuture development of diabetes . However, studies in the pediatricpopulation have been limited and no stan dard values of HbAlclevels in children have been established.Objective To evaluate HbAlc as a test for impaired glucosetolerance in obese children and adolescents and to identify theoptimal HbAlc thresh old level (cut off poin t).Methods We studied 65 obese and 4 overweight children (BMI 2::+ 2 SD for age and gender) aged 10-15 years in Palembang. Allsubjects underwent HbAlc and oral glucose tolerance tests.Results Nineteen out of 69 subjects (28%) had impaired glucosetolerance. Based on the receiver operating characteristic curve,the optimal cut off point of HbAlc related to impaired glucosetolerance as diagnosed by oral glucose tolerance test was found tobe 5.25%, with 63% sensitivity and 64% specificity, 40% positivepredictive value, and 82% negative predictive value. The areaunder the receiver operating ch aracteristic curve was O .68 7(95%CI 0.541-0.833; P < 0.00 1).Conclusion A HbAlc cut off value of 5.25% may be used as ascreening tool to identify children and adolescents with impairedglucose tolerance.

Latar belakang. Penderita penyakit ginjal kronis (PGK) berisiko mengalami abnormalitas mineral, sejalan dengan penurunan laju filtrasi glomerulus (LFG) atau peningkatan stadium PGK. Di Palembang, belum ada laporan mengenai penyakit mineral tulang pada anak akibat penyakit ginjal kronik. Tujuan. Penelitian ini bertujuan mengetahui kejadian penyakit mineral tulang pada anak dengan PGK.Metode. Penelitian potong lintang untuk mengetahui kejadian penyakit mineral tulang akibat PGK, dengan pemeriksaan kadar hormon paratiroid, kadar vitamin D, serta pemeriksaan densitas tulang. Subyek penelitian dibagi menjadi kelompok 1 (PGK stadium 1-2) dan kelompok 2 (PGK stadium 3-5). Hasil. Dari 28 subyek penelitian, rerata usia 10,7 tahun, rasio laki-laki dan perempuan, yaitu 2,5:1. Berdasarkan stadium PGK, 14 subyek dengan stadium 1. Rerata kadar hormon paratiroid pada PGK stadium 3-5 secara bermakna lebih tinggi. Subyek dengan PGK stadium 3-5 memiliki risiko 2x lebih besar mengalami hiperparatiroid. Kejadian defisiensi/insufisiensi vitamin D didapatkan pada 23 subyek (82%). Kejadian defisiensi/insufisiensi vitamin D tidak berbeda bermakna di antara kedua kelompok. Penurunan densitas tulang terjadi pada 8 subyek , 5 diantaranya osteopenia, dan 3 lainnya osteoporosis. Kesimpulan. Semua anak dengan PGK baik stadium 1-2 maupun 3-5 menunjukkan tanda kelainan mineral tulang secara laboratorium dan/atau densitometri.