Correlation of n-terminal pro-brain-type natriuretic peptide levels with the severity of single mitral regurgitation or accompanied by mild aorta valve dysfunction in patients with rheumatic heart disease in Sanglah general hospital

BACKGROUND

The most frequent abnormality of the valves involved in rheumatic heart disease is mitral regurgitation. A promising supportive diagnostic tool for rheumatic heart disease is the N-terminal pro-brain natriuretic peptide, which can identify mitral valve damage.

OBJECTIVE

To prove a positive correlation between N-terminal pro-brain natriuretic peptide levels and the severity of mitral regurgitation or accompanied by mild aortic valve dysfunction in children with rheumatic heart disease.

MATERIAL AND METHOD

Children aged 1-18 years who had been identified as having rheumatic heart disease with a single mitral regurgitation or accompanied by mild aortic issues at Sanglah General Hospital, Denpasar, met the inclusion criteria for this cross-sectional study. Mitral regurgitation severity was determined using the parameters of vena contracta width, effective regurgitation orifice area, regurgitant jet area, and regurgitation volume. Bivariate analysis using the Spearman correlation test.

RESULTS

From 36 research subjects, the mean age was 11.32 years. In this study, there was a moderate positive correlation between the levels of N-terminal pro-brain natriuretic peptide and the regurgitation jet area. N-terminal pro-brain natriuretic peptide levels also had a moderately positive correlation with the vena contracta width and a weakly positive correlation with the regurgitation volume. Effective regurgitation orifice area and N-terminal pro-brain natriuretic peptide levels did not significantly correlate.

CONCLUSION

There was a moderately positive correlation between N-terminal pro-brain natriuretic peptide levels and the severity of mitral regurgitation on regurgitation jet area, a moderately positive correlation with the vena contracta width, and a weakly positive correlation with regurgitation volume in rheumatic heart disease patients.

The relationship of vitamin D deficiency and childhood diarrhea: a systematic review and meta-analysis

INTRODUCTION

Vitamin D deficiency may increase the risk of childhood diarrhea. We aim to carry out a review and meta-analysis of the evidence relating vitamin D insufficiency to childhood diarrhea.

METHODS

We searched PubMed, Ovid, Scopus, and Cochrane Library (from inception to August 2022), then independently reviewed the eligibility, and read full-text reviews for selected articles. Keywords used were 'vitamin D', '25-hydroxyvitamin D', 'vitamin D deficiency', 'diarrhea', 'gastroenteritis', 'children', and 'pediatric'. The search was limited to studies only in English and with available full-text. Year limitation was not applied in our search. Unpublished trials, dissertations, preliminary reports, conference abstracts, and repositories were excluded from the study. Newcastle-Ottawa Scale was used as the risk of bias assessment tool. Meta-analysis using the random-effects model was done.

RESULTS

Out of 5,565 articles, 12 articles were included in our systematic review, however only 7 articles were eligible for meta-analysis. Meta-analysis showed a statistically significant association between vitamin D deficiency and diarrhea in children in developing countries (OR = 1.79; 95% CI = 1.15 to 2.80; p = 0.01). On the secondary outcome, the association of vitamin D deficiency and duration or recurrences of diarrhea are conflicting.

CONCLUSIONS

There is an association between vitamin D deficiency and the prevalence of diarrhea. Future studies should evaluate the causal association, the impact of vitamin D deficiency on the severity of diarrhea, and whether vitamin D deficiency treatments affects the prevalence of diarrhea.

Relationship between psychological stress with functional constipation in children: a systematic review

Introduction

constipation affects up to 29.6% of children worldwide, making it one of the most common gastrointestinal illnesses in the pediatric population. As a functional disorder, the development of constipation is mostly influenced by a child´s psychosocial condition, even considered as one of important contributing factors. This systematic review aims to evaluate the relationship between psychological stress with constipation in the pediatric population.

Methods

three online databases were searched as study sources, including PubMed, the Cochrane Library, and Google Scholar. Study selection was carried out using the PRISMA diagram. Studies that met the eligibility criteria were then included in the data extraction and synthesis. The study quality assessment was done using the Joanna Briggs Institute's (JBI) critical appraisal checklist.

Results

eleven studies are included in this systematic review, consisting of four cross sectional studies, four case control studies and three cohort studies. The included studies have good quality based on the assessment. Majority of the studies showed a significant relationship between psychological stress and constipation in children. Psychological stress in children can be classified into family-related stressors, school-related stressors, exposure to stressful life events, stress related to psychological disorders, and other factors.

Conclusion

psychological stress and burden are associated to constipation in children. To overcome functional constipation in children, a collaborative effort is required between parents, children, and the healthcare professional.

The Higher C-Reactive Protein Levels as a Risk Factor of Stunting in Children with Acyanotic Congenital Heart Disease

BACKGROUND: Children with acyanotic congenital heart disease (CHD) had a high risk of stunting. In addition to inadequate nutrition, chronic inflammatory process also plays an important role. An increase in serum c-reactive protein (CRP) suppresses insulin like growth factor 1 (IGF-1) production, causing disorder in child growth. AIM: The objective f the study was to prove that higher CRP levels as a risk factor of stunting in children with acyanotic CHD aged 6–24 months old. METHODS: This study is an observational analytic study with a case–control design, to assess higher CRP levels as a risk factor of stunting in children with acyanotic CHD aged 6–24 months old. This research was conducted at the Pediatric Cardiology Polyclinic, Sanglah Hospital from May to December 2021 with the consecutive sampling method. Data analysis was performed using the Chi-square test or Fisher’s absolute test. Multivariate analysis with binary logistic regression was performed on all variables. Significance level was p < 0.05. RESULTS: This study involved 60 subjects, consisting of 30 subjects with stunting and 30 subjects with no stunting. Children with stunting had higher mean CRP levels, 2.4 (±3.7) and 1.2 (±0.6). CRP level ≥3 mg/dL (p = 0.031; aOR 22.89; 95% CI 1.32–395.39) was a risk factor of stunting in children with acyanotic CHD. Other risk factors that significant are male, living in rural areas, low birth weight, and under-nutrition. CONCLUSION: Higher CRP levels as a risk factor of stunting in children with acyanotic CHD. Other significant risk factors include males, living in rural areas, low birth weight, and under-nutrition.

Serum iron is negatively correlated with the HbA1c level in children and adolescents with type 1 diabetes mellitus

Although mainly affected by the blood glucose levels, the level of HbA1c could be influenced by other important factors, such as an iron deficiency, which is commonly found in children with type 1 diabetes mellitus (T1DM). However, a clinical judgment could not be established, as previous studies still reported conflicting results and lack of data regarding Indonesia. We aimed to evaluate the correlation between the serum iron and HbA1c levels in children with T1DM. This single-center cross-sectional study was conducted from February to October 2020 at Sanglah Hospital, Bali, Indonesia. Patients aged 1–18 yr were included in this study. The HbA1c and serum iron levels were evaluated in the blood samples. Spearman and partial correlation analyses were used to analyze the correlations between variables. The statistical significance was set at P < 0.05. Thirty-three subjects were analyzed, with a mean age of 11.24 ± 3.76 yr. Low serum iron and poor glycemic index were found in 54.5% and 69.7% of the subjects, respectively. Spearman correlation analysis revealed a low negative correlation between the serum iron and HbA1c levels (Spearman’s rho = –0.376, P = 0.031). A partial correlation showed a moderate negative correlation (r = –0.473, P = 0.013) after adjusting for confounding variables. This study found a moderate negative correlation between the serum iron and HbA1c level in children and adolescents with T1DM.

Korelasi antara Kadar Seng Serum dengan Kadar Interleukin-6 dan Skor PELOD-2 pada Sepsis

Latar belakang. Sepsis merupakan penyebab utama morbiditas dan mortalitas pada anak dengan penyakit kritis yang dirawat di unit perawatan intensif anak (UPIA). Pada 24 jam sepsis, terjadi penurunan kadar seng serum dan secara bersamaan terjadi peningkatan kadar interleukin-6 (IL-6) dan skor PELOD-2. Hasil sebaliknya terjadi pada 72 jam sepsis.Tujuan. Untuk membuktikan korelasi negatif antara kadar seng serum dengan IL-6 dan skor PELOD-2 pada sepsis.Metode. Penelitian dengan rancangan potong lintang dua kali pengukuran dari Januari - Desember 2019 di UPIA RSUP Sanglah Denpasar. Subjek penelitian adalah anak berusia 29 hari sampai 18 tahun dengan sepsis berdasarkan skor PELOD-2 > 7 menggunakan metode consecutive sampling. Uji korelasi Pearson untuk menilai korelasi bivariat dan uji multivariat menggunakan uji korelasi parsial.Hasil. Empatpuluh subjek memenuhi kriteria inklusi. Rerata kadar seng serum pada 24 dan 72 jam adalah 59,5 µg/dl versus 64,2 µg/dl. Median IL-6 pada 24 dan 72 jam adalah 8,6 pg/dL versus 4,4 pg/dL, rerata skor PELOD-2 24 dan 72 jam adalah 11,2 versus 11,0. Korelasi Pearson kadar seng serum dengan kadar IL-6 pada 24 dan 72 jam adalah r= -0,078, p= 0,632 versus r= -0,218, p= 0,178. Korelasi Pearson kadar seng serum dengan skor PELOD-2 pada 24 dan 72 jam adalah r= -0,513, p= 0,001 versus r= 0,242, p= 0,132. Analisis korelasi parsial kadar seng serum dengan PELOD-2 pada 24 jam adalah r= -0,493, p= 0,002.Kesimpulan. Terdapat korelasi negatif sedang bermakna pada 24 jam sepsis antara kadar seng serum dengan skor PELOD-2 setelah mengontrol variabel kendali.

Toilet training and less fiber consumption as risk factors of constipation in preschool children

This study aimed to determine the prevalence and risk factors for children with constipation. This research was an analytic cross-sectional study. The sampling method was cluster sampling. The research was conducted at some kindergartens in Denpasar, Bali from October to November 2019. Data were obtained based on questionnaires distributed to parents and anthropometric examinations. Constipation was defined according to The Rome IV criteria. There were 215 children included in the study and 43 (20%) children had constipation. Children who started toilet training before the age of 1.5 years or after 2 years had 2,73 times the risk of developing constipation (p = 0.019; 95% CI 1.18-6.3). Children with less fiber consumption in a day had the risk of experiencing constipation 7.25 times (p = 0.001; 95% CI 3.38-15.5). Other risk factors such as sex, physical activity, screen contact, water consumption, nutritional status, birth weight, and mother education did not statistically relate to constipation. Toilet training before the age of 1.5 years or after 2 years and low fiber consumption are risk factors for constipation in preschool children in Denpasar.

Efficacy of Albendazole-Pyrantel Pamoate Compared to Albendazole Alone for Trichuris trichiura Infection in Children: A Double Blind Randomised Controlled Trial

Background

Soil transmitted helminths (STH) are intestinal nematodes and constitute one of the most neglected tropical diseases to exist. Objective: This study determined the efficacy of albendazole-pyrantel pamoate compared to albendazole in 8–12 years old children with Trichuris trichiura infection.

Methods

A randomised controlled trial was conducted between October 2017 and February 2018 on participants whose stool examinations confirmed the presence of Trichuris trichiura infection. The subjects were randomised into two groups. The statistical analysis used Chi-square test.

Results

There were 392 of 600 children at five public elementary schools in Bangli and Bali and were infected with Trichuris trichiura. The cure rate of Trichuris trichiura infection seven days following treatment was lower with the combination of albendazole and pyrantel pamoate compared to that of albendazole. The egg reduction rate of Trichuris trichiura infection was lower with the combination of albendazole and pyrantel pamoate compared to albendazole.

Conclusion

The study indicated that a combination of albendazole and pyrantel pamoate does not improve cure rate or egg reduction rate in 8–12 years old children with Trichuris trichiura infection.

Cystatin C level and amikacin use in neonatal sepsis

Background Amikacin is the antibiotic of choice for eradicating bacteria in neonatal sepsis because of its effectiveness against Gram-negative bacteria. However, this drug has nephrotoxic effects. Monitoring kidney function in neonates is very important because amikacin can interfere with development of the kidney. Several studies have shown that serum cystatin C levels were closer to glomerular filtration rate (GFR) values ​​compared to serum creatinine levels. Objective To evaluate cystatin C levels before and after administration of amikacin in neonates with sepsis. Methods This prospective cohort study was conducted in one group with a pretest and posttest design. Thirty neonatal sepsis patients who received amikacin therapy at Sanglah General Hospital, Denpasar, Bali, were included by consecutive sampling. Their cystatin C levels were measured before and after receiving amikacin therapy. Data were normally distributed and analyzed by paired T-test, with a value of P<0.05 considered to be significant. Results The mean difference was 0.23 [1.57 (SD 0.29) vs. 1.80 (SD 0.28)] mg/L with P value < 0.001. There was different value of cystatin c level before and after amikacin therapy with deviation standard 0.25 with P<0.001 (alfa 5%). Conclusion Cystatin C levels are significantly higher in neonates with sepsis after administration of amikacin.

Liver function in children with human immunodeficiency virus infection before and after 6 months of highly active antiretroviral therapy

Background Highly active antiretroviral therapy (HAART) has resulted in dramatic decreases in morbidity and improved survival rate in human immunodeficiency virus (HIV)-infected patients. Although the risk of morbidity has decreased, it has been replaced by other long-term complications, such as hepatotoxicity. Hepatotoxicity is often reflected in biochemical abnormalities of liver function, such as elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and aspartate aminotransferase-to-platelet ratio index (APRI). Objective To compare liver function spectrum (AST, ALT, and APRI) in HIV-infected children before and after at least 6 months of HAART. Methods This observational study (before and after) was conducted in pediatric patients with HIV infection who received HAART for at least 6 months at Sanglah Hospital, Denpasar. Data were collected from medical records. Results Forty-nine patients were observed in this study. The mean AST, ALT, and APRI levels before HAART were higher than after at least 6 months of HAART. Anti-tuberculosis treatment and fluconazole therapy were not confounding factors for AST, ALT, and APRI. Conclusion Liver function spectrum enzyme levels of AST, ALT, and APRI are improved after at least 6 months of HAART.

Effect of probiotics supplementation on acute diarrhea in infants: a randomized double blind clinical trial

Background Probiotics has advantages as a supplement formanagement of infants with acute diarrhea. It influences theduration of diarrhea by enhancing immune responses, elaboratesantimicrobial substances and occupies intestinal mucosal sites,inhibits the attachment and the growth of pathogenic organismsby achieving competitive exclusion and microbial balance.Objective To assess the clinical effects of probiotics supplementationon acute diarrhea in infants.Methods This was a double blind, randomized clinical controlledtrial performed on infants aged 1-12 months old with acutediarrhea, hospitalized in Sanglah Hospital, Denpasar. Subjectswere divided into two groups; the treatment group had standardmanagement with adjuvant probiotics, while the control groupreceived standard management with placebo.Results From 70 infants enrolled in this study, the mean durationof diarrhea in treatment group was significantly shorter than thatin the placebo group, 49.03 hours (SE 3.09) (95%CI 42.98;55.08)vs 73.03 hours (SE 3.28) (95%CI 66.61;79.45); P=0.001.Regarding failure of the treatment, probiotics supplementationhad relative risk reduction (RRR) of 67% and absolute riskreduction (ARR) of 57%. In multivariate cox regression analysisit was found that only probiotics supplementation influenced theduration of acute diarrhea in infants.Conclusion Probiotics can shorten the duration of acute diarrhea,and is safe as an adjuvant to standard management for infantswith acute diarrhea.