Background The prevalence of low birth weight (LBW) is still
AbstrakLatar belakang: Peningkatan jumlah sindrom metabolik (MetS) (OR 12,13; 95% CI 2,46; p = 0,001), tekanan darah tinggi (OR 9,33; 95% CI 2,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)56; p = 0,001), HDL rendah (OR 8,33; 95% CI 2,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)05; p = 0,003), and glukosa puasa terganggu (p = 0,03) . Empat subjek mempunyai FRS ≥ 1% dan 66 subjek berisiko < 1%. Peningkatan FRS tidak berhubungan dengan MetS (p = 0,154). Tidak ada komponen MetS berhubungan dengan peningkatan FRS. Kesimpulan: Prevalensi MetS pada dewasa muda dengan obesitas hampir sama dengan pada anak-anak dan remaja dengan obesitas. Walaupun tidak didapatkan hubungan antara MetS dan FRS, keduanya merupakan AbstractBackground: The increase number of the metabolic syndrome (MetS) among young adults was mostly caused by obesity. MetS increases the risk of coronary heart disease (CHD) which can be estimated by Framingham risk score (FRS). The study was aimed to know the prevalence of MetS and FRS in obese young adults and to associate them with the components of MetS.
ABSTRAK p = 0,048). Adapun lama DM,[2][3][4][5][6][7][8][9][10][11][12][13] p = 0,976), obesitas (37% vs 38%, p = 0,897), usia (53,2 ± 10,5 vs 54,7 ± 9,3, p = 0,481) ABSTRACTBackground: One of the most neglected complications of diabetes mellitus (DM) is gastro-esophageal reflux disease (GERD) which arises from autonomic neuropathy and diabetic gastropathy related to the extent of DM. This study was done to find prevalence of GERD in DM patients with GERD-questionnaire (GERDQ), dietary factor proportion, and their association with other GERD risk factor in rural area.Methods: This cross sectional study was conducted in Puskesmas Pelaihari from August to September 2013. Subjects with DM aged ≥ 18 were selected consecutively from both newly and previously diagnosed patients with exclusion criteria: pregnancy, in proton-pump inhibitor therapy, and had other metabolic disease(s). DM was diagnosed with ADA criteria, while GERD was diagnosed in patients with score of ≥ 8 of Indonesian GERDQ.Results: There were 30 subjects (29.7%) with GERD among 101 patients with DM and dietary factors found in GERD patients were spicy diet (90%), high-fat food (90%), irritative beverages (87%), and irritative diet (23%). Only female gender was associated with GERD vs non-GERD in DM patients (87% vs 68%, p = 0.048). Meanwhile, duration of DM (2 [0-13] vs 2 [0-19], p = 0.976), obesity (37% vs 38%, p = 0.897), age (53.2±10.5 vs 54.7 ± 9.3, p = 0.481), and uncontrolled diabetes (90% vs 94%, p = 0.421) were not associated with the GERD among DM patients. Conclusion:Prevalence of GERD in DM is somewhat high in this study. Female group with DM needs to be screened for GERD as early as possible.
Abstrak Penyakit refluks gastroesofageal berat (PRGE)adalah gerakan retrograd isi lambung ke kerongkongan. Pada prematuritas, kelemahan peristaltik esofagus terjadi akibat kurangnya relaksasi reseptif bersihan material refluks ke esofagus. Penyakit ini menyebabkan penurunan kualitas hidup dan komplikasi. Laporan ini bertujuan menggambarkan kasus PRGE parah pada anak marasmik dengan kelahiran prematur. Kasus berasal dari seorang anak perempuan berusia tiga tahun dirawat di Rumah Sakit Umum Cipto Mangunkusumo karena menderita muntah terus-menerus setiap kali setelah menyusu. Pasien lahir prematur pada usia kehamilan 31 minggu dengan berat lahir 900 gram, mengalami malnutrisi berat dan keterlambatan perkembangan. Pasien menjalani prosedur endoskopi, pemeriksaan histopatologi dan didapatkan esofagitis berat, gastritis erosif, striktur pilorik, dan refluks laringofaringeal (LPR).Pasien diberikan proton pump inhibitors (PPIs), menjalani dilatasi pilorik satu kali dan pemasangan nasogastricjejunal feeding tube (NJFT), serta susu formula khusus medium chain tryglyceride (MCT) enam kali sehari. Dalam 18 bulan masa tindak lanjut, pasien menunjukkan peningkatan skor Z berat-berdasarkan-panjang badan, panjang berdasarkan usia dan lingkar kepala berdasarkan usia.Dalam menangani bayi prematur, harus mempertimbangkan PRGE sebagai salah satu etiologi pertumbuhan yang terganggu. Prosedur endoskopi dan pemasangan NJFT untuk terapi nutrisi jangka panjang mengurangi komplikasi dan meningkatkan kualitas hidup.Follow up intensif diperlukan agar mencapai pertumbuhan dan perkembangan optimal. Kata kunci: anak, komplikasi, GERD, lahir prematur, proton pump inhibitors Severe Gastroesophageal Reflux Disease in Malnourished Children with History of Prematurity Abstract Gastroesophageal reflux disease (GERD) is an involuntary retrograde propulsion of gastric contents to esophagus. In prematurity, esophagus peristaltic weakness due to lack of receptive relaxation contribute to inadequate cleaning of material reflux to esophagus which become GERD predisposition. Furthermore, GERD can cause a decline of quality of life and various complications. This report aimed to describe severe GERD case in a marasmic child with premature birth. A 36-month-old girl was hospitalized at dr. Cipto Mangunkusumo General Hospital because of persistent vomitus after every milk feeding. She was prematurely born at 31 weeks of gestation with birthweight of 900 grams, and become severely malnourished with developmental delayed. She then underwent gastrointestinal endoscopic procedure and histopathology examination that revealed a severe esophagitis, erosive gastritis, pyloric stricture, and laryngopharyngeal reflux (LPR).She was treated with proton pump inhibitors (PPI) and underwent one-time pyloric dilatation with nasogastricjejunal feeding tube (NJFT) insertion and continued with medium chain triglycerides formula six times a day. At 18-month follow-up, weight-for-length Z score, length-for-age and head circumference Z score are increased.In dealing with premature baby, we should consider GERD as one of growth faltering etiologies. Endoscopy procedure followed by NJFT insertion for long-term nutrition therapy in severe GERD are the cornerstones to reduce complications and to improve quality of life. Moreover, close follow up for optimal growth and development should be done in such case. Keywords: children, complications, GERD, premature birth, proton pump inhibitors
Background. Pneumonia is one of the most common causes of morbidity and mortality in children below 5 years of age. Most cases occur in low-middle income countries. The introduction of Pneumococcus Conjugate Vaccines (PCV) became an alternative way to prevent pneumonia, but limited fundings restrict implementation of PCV in national immunization program especially in developing countries. It is important to explore the effectivity and efficiency PCV10 compared to PCV13 to prevent pneumonia. Aim. To identify the immunogenicity and efficacy of PCV10 compared to PCV13 among infants in developing countries. Method. Electronic online literature searching was conducted through Pubmed and Cochrane with keywords PCV10, OR PCV13, AND pneumonia, AND immunogenicity, AND infants. Results. Two relevant articles were available and then were appraised. A study by Pomat et al with 1b level of evidence found the incidence of pneumonia for after PCV10 and PCV13 immunization were 25% and 19%, respectively. Protective IgG concentration for all serotypes (≥0,35 mcq/mL) after the administration of three primary doses (3+0) for either PCV10 or PCV13 was found to be available in 77% subjects at 4 months old. Temple et al (1b level of evidence) showed the proportion of subjects with protective IgG concentration for all serotypes in both PCV10 and PCV13 groups is 76.8-100%. Conclusion. Either PCV10 or PCV13 has almost similar effectivity and efficacy for immunogenicity and preventing the incidence of pneumonia. Other considerations in vaccine selections are local pneumococcal serotypes, price, and availability of vaccines for the long run.
Background Post-chemotherapy febrile neutropenia results in high morbidity and mortality in children with malignancy. Many prognostic factors, such as microorganism patterns, as well as the use of antibiotics and antifungals can affect the outcomes. However, limited study is available in Indonesia. Objective To determine the microbial profiles, antibiotic sensitivity, and other factors that influence mortality from febrile neutropenia in pediatric malignancies with infections. Methods This retrospective cohort and descriptive study of 180 children with 252 episodes of neutropenic fever was done in Cipto Mangunkusumo Hospital, Jakarta, between 2015 and 2017. Medical history of possible predictive prognostic factors, including microorganism patterns and antibiotic sensitivity, were recorded. Prognostic factors were analyzed using multivariate logistic regression tests. Results The most common bacteria was Gram-negative (54.5%), while Candida sp. was the most common fungal infection (82.5%). Klebsiella sp. was mainly sensitive to amikacin (85.71%), while Pseudomonas aeruginosa was sensitive to ceftazidime (75%), as well as amikacin and gentamicin (100% sensitivity in combination). Staphylococcus sp. was mainly sensitive to amoxi-clav and ampi-sulbactam (76.9%). Almost all fungal groups were susceptible to fluconazole, ketoconazole, voriconazole (80-100%). Prognostic factors that increased mortality risk were central venous cannulation (RR 1.947; 95%CI 1.114 to 3.402), wasting (RR 1.176; 95%CI 1.044 to 1.325), severe wasting (RR 1.241; 95%CI 0.975 to 1.579), and hematologic malignancies (RR 0.87; 95%CI 0.788 to 0.976). Conclusion Central venous cannulation and wasting are significant prognostic factors of increased mortality in children with febrile neutropenia. Gram negative bacteria along with Candida sp. is the most common pathogen in such condition.
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