BACKGROUND: Sepsis in children with cardiovascular involvement can increase mortality. Recently, many studies have been conducted to investigate troponin as an early marker of myocardial dysfunction, associated with pediatric sepsis score. Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score is recent scoring to assess organ dysfunction in sepsis children. AIM: To determine the correlation between troponin T, troponin I with PELOD-2 score in sepsis as a predictive factor of mortality. METHODS: A prospective cohort study was conducted on sepsis children in PICU Haji Adam Malik General Hospital, Medan. Assessment of PELOD-2 score, serum troponin T, and troponin I levels performed on the first day and 48 hours after sepsis was diagnosed. Patients were observed until moved to the ward or died. RESULTS: A group of 41 subjects were recruited in this study. Troponin T level at 24 hours did not correlate with PELOD-2 scores. Troponin T level at 48 hours was positively correlated with PELOD-2 score (r = 0.771, p < 0.001) and had a significant association with the mortality rate (p < 0.001). Troponin T at 48 hours could be used as a predictive factor of mortality (AUC 86.4%, p < 0.001) with a cut-off point of 40.3 ng/mL (76% sensitivity, 75% specificity, RR 2.48). Troponin I levels at 24 and 48 hours also had strong correlation with PELOD-2 score (r = 0.326, p = 0.037; r = 0.691, p < 0.001) and could be used as a predictor of mortality in pediatric patients with sepsis (AUC 74.8%, p 0.008; AUC 92.6%, p < 0.001). The cut-off point of troponin I at 24 hours was 0.075 ng/mL (68% sensitivity, 68.8% specificity, RR 1.84) and at 48 hours was 0.125 ng/mL (80% sensitivity, 81.3% specificity, RR 3.13). CONCLUSION: Serum troponin T and troponin I levels at 48 hours have positive correlation with PELOD-2 score as a predictive factor of mortality in pediatric patients with sepsis.
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.
BACKGROUND:Beta thalassemia major is associated with lipid profile abnormalities, presented as a lower level of total cholesterol (TC), low-density lipoproteins (LDL), high-density lipoprotein (HDL), and higher triglyceride level; increasing risk for cardiovascular complications. The previous studies indicated that Vitamin D give a positive impact on the lipid profile in healthy children population. However, its role needs to be determined in a high-risk group of children with beta-thalassemia major.AIM:To determine the correlation between vitamin D (25-OHD) and lipid profile among children with beta-thalassemia major.METHODS:A cross-sectional study was conducted in a general tertiary hospital in Medan, Sumatera Utara, Indonesia from January to March 2018. Subjects were children aged below 18-year-old with beta-thalassemia major. The measurement of vitamin D (25-OHD) level and 10-12 hour overnight fasting serum lipid profile including total cholesterol, triglyceride, HDL, and LDL were performed. The analysis was done using Pearson’s correlation and Fisher test. P value < 0.05 was considered significant.RESULTS:Forty-five subjects were enrolled in this study, with serum ferritin level ranged from 1017 to 13372 ng/mL. The prevalence of vitamin D deficiency (a 25-OHD level less than 20 ng/mL) in this study was 40%, with mean value at 20.6 (SD 5.3) ng/mL. The markers for cardiovascular risk were observed to be elevated, both in Atherogenic Index Plasma (0.32 ± 0.25) and TC: HDL ratio (4.2 ± 1.5). Statistical analysis revealed that Vitamin D had positive correlation with total cholesterol (r = 0.302, p = 0.044) and HDL (r = 0.297, p = 0.048). There was no significant correlation between both vitamin D and triglyceride (p = 0.305), or vitamin D and LDL (p = 0.727).CONCLUSION:Vitamin D correlated positively with total cholesterol and HDL in children with beta-thalassemia major. Positive correlation to HDL indicated a beneficial effect of vitamin D to reduce the risk of cardiovascular complication.
Background Red cell distribution width (RDW) is a hematological
BACKGROUND: Sepsis in children is a significant cause of morbidity and mortality in the pediatric intensive care unit (PICU). Assessment of pediatric sepsis using serial Pediatric Logistic Organ Dysfunction (PELOD)-2 score can be used as a prognostic factor. The use of biomarkers of sepsis is also used for diagnosis and predicting outcomes. Many studies have suggested that C-reactive protein (CRP) and procalcitonin (PCT) can be used to predict mortality.METHODS: A prospective cohort study was conducted to evaluate CRP, PCT, PELOD-2 score and its combination as a predictive factor of mortality in sepsis. All patients admitted to PICU Haji Adam Malik General Hospital, Medan, from April to November 2019 with suspected sepsis were included in this study. Blood examination and PELOD-2 scores were examined in the first 24 hours.RESULTS: A total of 79 children were included with a mortality rate 55.7%. The CRP, PCT, and PELOD-2 score were higher in nonsurvivor (2.8 (0.5-22.4) mg/dL; 9.36 (0.13-79.8) ng/mL; 9 (3-21), respectively). In multivariate logistic regression analysis, neither CRP nor PCT values could be independent predictors of mortality. The PELOD-2 score can be an independent predictor for mortality at a cut-off score of 7 (OR: 3.47 (95% CI: 1.68-7.19)). The combination of PELOD-2 and CRP scores as predictors of mortality showed lower values than PELOD-2 and PCT scores (0.80 vs. 0.95). The combination of all parameters only adds 1% of the predicted mortality value.CONCLUSION: PELOD-2 score with PCT value are recommended to predict mortality children with sepsis.KEYWORDS: sepsis, mortality, C-reactive protein, procalcitonin, PELOD-2 score
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