Hypocalcemia is a common complication after total thyroidectomy due to acute hypoparathyroidsm post-surgery. The incident varies from 7%-69% depends on the surgery center. The management is divided based on the onset and symptoms. Carpal-pedal spasm, seizure, bronchospasms are the emergency symptoms of hypocalcemia that require administration of intravenous calcium. However the management of asymptomatic hypocalcemia with oral calcium, vitamin D and hydrochlorothiazide can be difficult due to wide fluctuations of serum calcium and the risks of complication. Hereby we report a 14-year-old girl with hypocalcemia due to hypoparathyroidsm post modified bilateral radical neck dissection and total thyroidectomy. She had papillary thyroid carcinoma and lymph node metastases. After surgery, she developed classic sign of hypocalcemia, numbness in extremities which progressed to cramps. Physical examination revealed chvostek’s sign. Laboratory examination showed critical value of hypocalcemia with normal level of albumin, hypoparathyroidsm and hypovitaminosis D. The initial treatment was started by giving intravenous calcium gluconate 10% and calcitriol. Monitoring level of calcium and phosphate were performed regularly. Calcium level was maintained by giving high dose of elemental calcium, vitamin D3 and hydrochlorothiazide followed.
Malnutrition is a major health problem in developing countries, it can occur acutely, chronically or combination of both. Malnutrition aggravates the condition of infectious diseases, including intracranial infections. Hereby we aimed to determine the prevalence and factors associated with malnutrition in pediatric patients with intracranial infections in Sanglah Central General Hospital. This cross-sectional analytic study was conducted in patients with final diagnosis intracranial infection whom were treated from January 2019 to March 2021. The study was conducted in pediatric patients aged 1 month-18 years old and patient would be excluded if had any of these conditions: 1) incomplete medical records, 2) discharge by his/her own request, 3) hydrocephalus for which VP shunt had not been performed, 4) diagnosis of tumor or mass that could affect body weight measurement. Secondary data such as weight/height for children <5 years and BMI/age for children >5 years were measured in growth curve by using the WHO Anthro application. Total samples were 83 children with predominance age group was 0-5 years old. Malnutrition was found in 48.1% patients. Chronic malnutrition was more common than acute malnutrition (32.5% vs. 31.3%). Age below 5 years has relationship with the incidence of acute malnutrition in pediatric patients with intracranial infection (p: 0.008, 95% CI: 0.076-0.675). The incidence of malnutrition in children with intracranial infections in Sanglah Hospital during January 2019 to March 2021 was 48.1%, and age < 5 years had significant relation to the incidence of malnutrition in children with intracranial infections.
Background: The delay in cognitive and language development can be caused by multifactor, including chronic deficiency of micronutrient, zinc. Level of zinc serum is influenced by food intake which can cause bias. There are inconsistencies in previous studies between zinc levels and the development caused by differences of sample or subjects. This study using hair as sample in analyzing the association between zinc level on cognitive and language delays in children aged 9-24 months old. AIM: To find out that low hair zinc level is associated with delayed of cognitive and language development in children 9-24 months old. Method: This analytical observational study with case-control design. Case group consisted of 69 children with cognitive and language development delays, based on CAT/CLAMS scores < 85 subjects aged 9-24 months meanwhile the control group consist of 69 children with normal cognitive and language development. Chi-square test was used to assess the association between zinc levels and the incidence of cognitive and language delays. Multivariate analysis was performed by logistic regression. Results: Univariate analysis showed no association between low zinc level and delayed of cognitive and language development in children aged 9-24 months (OR 1.263; 95% CI 0.64-2.46; p=0.495). Logistic regression was performed for other variables and screen time > 2 hours and lack of stimulation were risk factors for cognitive and language development delays (adjusted OR 2.78; 95% CI 1,284-6.058; p=0.010 and adjusted OR 3.96; 95% CI 1.833-8.581; p<0.001). Conclusion: There is no relationship between low hair zinc level and delays in cognitive and language development in children age 9-24 months, but there is an association between screen time more than two hours per day and lack of stimulation with delays in cognitive and language development in children 9-24 months 24 months.
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