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.

Correlation between Interleukin-6 and Ferritin Serum in Pediatric Sepsis Patients

BACKGROUND: Sepsis is the leading cause of death in children. Sepsis is caused by dysregulation of  immune system that triggers the production of pro-inflammatory cytokines, one of which is interleukin-6 (IL-6). In addition several markers of infection also increase such as c-reactive protein (CRP) and procalcitonin (PCT), moreover in sepsis serum ferritin also increase. Serum ferritin is secreted by stimulation of pro-inflammatory cytokines such as TNF-α, interleukin-1 (IL-1) and IL-6 that occur in the inflammatory process. AIM: to prove correlation between Interleukin-6 and ferritin serum in pediatric sepsis patient. METHOD: This was cross-sectional study. Subjects were children aged 1 month-18 years with sepsis in pediatric intensive care unit (PICU) and intermediate ward (IW) at Sanglah General Hospital Denpasar in period of September 2020 – June 2021. Statistical analysis was done by Pearson correlation test. RESULTS: Total 37 subjects were analyzed in this study. The median level of Interleukin-6 was 12 pg/ml (range, 1-355 pg/ml) and the median of ferritin level was 997 (range, 180-13418 ng/mL). The correlation between interleukin-6 and serum ferritin showed moderate positive correlation (r=0.54) which was statistically significant (p=0.001). After adjusting for the confounding variables, namely age, gender, nutritional status and time of sampling using partial correlation, the correlation between IL-6 and ferritin became strong with r=0.702 and p=0.00. CONCLUSION: There was a significant positive correlation after adjusting for the confounding variables between Interleukin-6 level and ferritin in pediatric sepsis patient.  

Malnutrition as Risk Factor for Febrile Neutropenia in Children with Acute Lymphoblastic Leukemia

BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Febrile neutropenia is one of medical emergencies in ALL patients. One of the risk factors that associate with febrile neutropenia is malnutrition. Malnutrition reduce the body’s immunity that increase incidence of infection. AIM: aimed to prove malnutrition as risk factor in children with ALL who had febrile neutropenia METHOD: This is case-control study with samples a hundred children aged 1 month to 18 years old with ALL at Sanglah Hospital Denpasar between 2015 - 2021. Subjects were grouped into two, those with febrile neutropenia and without febrile neutropenia.  The relationship between malnutrition and febrile neutropenia was analyzed by using chi-square bivariate analysis test.   RESULTS: A hundred subjects were devided into two groups with 50 subjects each group. Bivariate analysis showed significant association between malnutrition and febrile neutropenia (OR 4.53; 95%CI 1.95 - 10.51; p-value <0.001). CONCLUSION: Malnutrition as risk factor for febrile neutropenia in children with ALL.  

The Differences in Transaminase Enzyme Levels among Children with Acute Diarrhea due to Rotavirus and Non-rotavirus

BACKGROUND: Diarrhea is the particular disease that still affects children in Indonesia, with rotavirus being the most common etiology among children under 5 years old. Rotavirus and non-rotavirus diarrhea can spread to the extraintestinal and localized to the liver which causes liver cell damage, thus, the level of the glutamic oxaloacetic and glutamic pyruvic transaminase enzymes increases. AIM: The objective of the study was to prove that there are differences in serum levels of glutamic oxaloacetic and glutamic pyruvic transaminase in children with acute diarrhea due to rotavirus and non-rotavirus infection. METHODS: This study used a cross-sectional design, the research subjects were children aged 6 months old until 60 months old with acute diarrhea in Denpasar Public Health Center, Sanglah, and Wangaya General Hospital within the period of March 2018 until March 2021. Statistical analysis used the Mann–Whitney. RESULTS: A total of 70 subjects were analyzed in this study. There were 24.28% of subjects with rotavirus. Each group had nearly the same degree of severity of 29.4% for rotavirus and 30.2% for non-rotavirus, with a median of serum levels of glutamic oxaloacetic transaminase (SGOT) 47 (19–261) and glutamic pyruvic transaminase (SGPT) 25 (7–217). The results of this study showed that the median difference in aspartate aminotransferase and alanine aminotransferase levels was not significant in rotavirus and non-rotavirus diarrhea (SGOT 45 [16–168], 32 [11–261], p = 0.077; (SGPT 22 [14–91], 18 [5–217], p = 0.12). CONCLUSION: This study concluded that there is a higher median level of SGOT and SGPT in children with acute diarrhea due to rotavirus infection compared to non-rotavirus infection, although it is not statistically significant.

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.

Correlation between Serum Level of Matrix Metalloproteinase-2 with Left Ventricular End-diastolic Volume in Children with Heart Failure

BACKGROUND: Left ventricular end-diastolic volume (LVEDV) on echocardiography is one of the tests performed on heart failure. This refers to the volume of the left ventricle at the end of the diastolic phase, which would be increased when there is a disturbance in preload, afterload, and contractility factors. Matrix metalloproteinase-2 (MMP2) is a marker of congestive heart failure that can be examined through laboratory examinations. AIM: The objective of the study was to provide evidence of the association between MMP and inflammatory process as well as its correlation with LVEDV in children with heart failure. METHODS: This was a cross-sectional study conducted on children aged 3 months–12 years old with heart failure, who visited Sanglah Hospital, Denpasar, Indonesia from May 2017 to March 2018. Echocardiographic examination (LVEDV) and blood samples were taken to measure the serum level of MMP2 on day 1 after the subjects were diagnosed with heart failure. RESULTS: A total of 32 subjects with heart failure were analyzed in this study. Acyanotic congenital heart defect (CHD) was the most common cause of heart failure, as observed in 23 subjects (71.9%). Characteristics data revealed that 24 subjects (75%) were underweight, 23 (71.9%) had cardiomegaly, and 22 (68.8%) had mild heart failure. Data analysis showed a moderate positive correlation between MMP2 levels with LVEDV after controlling for the influence of age (p = 0.02; r = 0.425). CONCLUSION: There was a moderate positive correlation between MMP2 level and LVEDV after controlling for the age factor.

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.

Pengaruh Formula Bebas Laktosa Terhadap Lama Diare dan Elektrolit Serum pada Anak dengan Diare Rotavirus

Latar belakang.Diare akut rotavirus menyebabkan kerusakan mukosa, vili usus menjadi tumpul dan pendek, serta kematian sel. Proses tersebut juga mengurangi sekresi enzim laktosa yang bertanggung jawab dalam penyerapan laktosa. Laktosa yang tidak terserap menyebabkan berkembangnya diare osmotik yang mengakibatkan kehilangan cairan dan elektrolit. Formula bebas laktosa dapat diserap tanpa membutuhkan enzim laktose, sehingga lama dari episode diare dapat dipersingkat.Tujuan.Untuk membandingkan lama diare dan elektrolit serum pada bayi dan anak dengan diare rotavirus setelah pemberian nutrisi formula bebas laktosa dibandingkan dengan formula standar.Metode.Uji klinis acak terkontrol tersamar ganda desain pararel, pada anak usia t6-d59 bulan dengan diare akut, dibagi 2 kelompok dengan besar sampel masing-masing 30 (kelompok A formula bebas laktosa; B formula standar). Latex agglutination testdigunakan untuk mendeteksi rotavirus. Setelah dilakukan rehidrasi, diberikan intervensi. Observasi dilakukan tiap 6 jam untuk mengetahui durasi diare, berat badan, dan frekuensi defekasi. Analisis statistik dengan paireddanindependent t-testdan analisis multivariat (cox regression).Hasil. Rerata lama diare pada kelompok bebas laktosa 57,59 jam (SB 9,40) dan formula standar 85,97 (SB 13,94) jam, dengan beda rerata 28,38 (SE 3,09) jam (IK95% 22,19;34,56; p=0,001). Penurunan frekuensi defekasi bermakna pada kelompok bebas laktosa, tetapi tidak bermakna pada peningkatan berat badan. Analisis multivariat menunjukkan hanya intervensi yang diberikan berpengaruh secara bermakna terhadap lama diare diare. Rerata peningkatan serum elektrolit hanya bermakna pada serum natrium, yaitu pada kelompok formula bebas laktosa dengan rerata 1,62 (SB4,20) mEq/L (IK95% -2,83;0,41; p=0,01).Kesimpulan. Formula bebas laktosa dapat mempersingkat lama diare dan meningkatkan kadar serum natrium pada diare rotavirus.

Kolestasis pada Sepsis Neonatorum di RSUP Sanglah, Denpasar

Latar belakang. Kolestasis neonatal masih merupakan permasalahan dibidang ilmu kesehatan anak. Angka kejadian kolestasis intrahepatal yang disebabkan oleh sepsis sebesar 65,9% dengan angka kematian pada neonatus 52,8%.Tujuan.Mengetahui prevalensi dan luaran, faktor berhubungan dengan kejadian kolestasis pada sepsis neonatorum.Metode.Desain potong lintang analitik pada neonatus terbukti sepsis, pengambilan data rekam medik dari Januari 2008 sampai dengan September 2010.Hasil. Prevalensi kolestasis 38,9% dengan penyebab terbanyak bakteri Gram negatif yaitu Serratia Marcescens (19,2%). Lama rawat t15 hari kolestasis dengan RR 1,57 (IK 95% 0,029-0,116), rerata lama puasa 8,8 hari ±6,81), p=0,001, rerata lama pemberian nutrisi parenteral 14,2 hari (SD=8,26), p=0,001 merupakan faktor yang signifikan untuk terjadi kolestasis. Kadar rerata CRP 97,51 (74,94), kadar IT ratio 0,07 (0,05), kadar trombosit 60.250 (60,950) bermakna berhubungan dengan kolestasis. Mortalitas pada sepsis neonatorum dengan kolestasis 23,3%. Kesimpulan.Prevalensi kolestasis pada sepsis neonatorum di RSUP Sanglah Denpasar didapatkan 38,9%. Faktor lama rawat t15 hari, lama puasa serta pemberian nutrisi parenteral dan rerata kadar CRP, IT ratio, serta kadar trombosit bermakna untuk terjadi kolestasis, dan angka kematian sepsis neonatorum dengan kolestasis 9%.

The value of IgG to IgM ratio in predicting secondary dengue infection

Background The determination of primary or secondary dengueinfection using hemagglutination inhibition (HI) test is time-con-suming. The IgG to IgM ratio which can be obtained earlier wasused by several studies to differentiate secondary from primaryinfection, but they still reported various cut-off points.Objective To find the diagnostic value and best cut off point ofIgG to IgM ratio for predicting secondary dengue infection.Methods This was a prospective study carried out between July2003 and June 2004. Children with suspected dengue hemor-rhagic fever (DHF) were tested for HI during acute and convales-cent phase. The IgG and IgM titer were examined during the acutephase using ELISA method.Results Sixty-two children were recruited, 48 with secondary in-fection and 14 with primary infection. The prevalence of second-ary infection was 77%. The best cut off point of the IgG to IgM ratioto predict secondary infection was >1.1 with sensitivity of 87.5%,specificity 92.9%, likelihood ratio 12.3, and post test probability97.7%.Conclusion The IgG to IgM ratio of >1.1 is a good predictor forsecondary infection

Fava bean–induced hemolytic crisis in glucose-6-phosphate dehydrogenase deficiency

This paper reports a case of hemolytic crisis dueto fava beans in a child with G6PD deficiency.

Probiotic therapy on children with allergic rhinitis

phils in nasal secretions of patients with allergic rhinitis may cause persistent nasal blockage. A common therapy for allergic rhinitis is oral or intranasal corticosteroids. However, corticosteroids carry the risk of disrupting growth and development in children. Probiotic treatment in allergic rhinitis patients works by manipulating the bacterial ecosystem of the digestive tract, stimulating the balance of Th1 and Th2 immune responses.Objective To assess the effects of probiotic supplementation on eosinophil levels in nasal secretions, duration of allergic episodes, and total nasal symptom scores in children aged 2-18 years with allergic rhinitis.Methods A randomized, double-blind, controlled trial was performed on children aged 2 to 18 years who visited Sanglah Hospital, Denpasar, between March to July 2012 due to allergic rhinitis. Fifty-five eligible subjects were involved in the study. Subjects were randomly allocated to receive either standard therapy (antihistamines) and probiotics or standard therapy and placebo for 30 days. Mann-Whitney test was used for statistical non-parametric unpaired samples analysis. P values of <0.05 were considered to be statistically significant.Results Fifty-five subjects with allergic rhinitis were randomized into either the probiotic group (27 subjects) or the placebo group (28 subjects). We found that the median (range) nasal eosinophil percentage reduction before the study compared to after 30 days of treatment was higher in the probiotic group than in the placebo group (34 (15-65) vs 6 (0-24) %, respectively, P<0.0001). Median (range) duration of allergic rhinitis episode in the probiotic group was shorter compared to the placebo group (48 (0-96) hours vs 72 (6-168) hours, respectively; P<0.0001). The median (range) total nasal symptom score was also lower in the probiotic group compared to the placebo group (2 (0-3) vs 5 (1-6), respectively; P<0.0001).Conclusion Probiotic supplementation reduces the percentage of nasal eosinophils, duration of allergic rhinitis episode, and total nasal symptoms.

Efficacy of synbiotic treatment in children with acute rotavirus diarrhea

Background Diarrhea is one of the major causes of morbidityand mortality in children throughout the world, mostly due torotavirus infection. In daily practice, we routinely use the WorldHealth Organization Five steps for managing acute diarrhea.Thispractice has shown great success in diarrhea management, butconcerns remain on reducing the duration of diarrhea to preventcomplications. Synbiotics can reduce the severity of diarrhea.However, there has been limited data on synbiotic therapy fortreating acute rotavirus diarrhea in children.Objective To compare the durations of acute rotavirus diarrheatreated with synbiotics vs. placebo.Methods This study was a randomized, double-blind, clinical trial,performed at the Pediatric Gastrohepatology Division, Sanglahand Wangaya Hospitals in Denpasar. Subjects were children aged6 to 59 months with acute rotavirus diarrhea. Rotavirus wasdiagnosed by immune chromatography assay. The synbiotic groupreceived probiotic comprised of Lactobacillus sp., Streptococcus sp.,Bifidobacterium sp. (total viable count 1.00x109 CFU per dose), andprebiotic consisted of 990.00 mg fructooligosacharide (FOS). Theplacebo consisted of lactose monohydrate packaged similarly as thesynbiotics. Subjects orally ingested 1 pack per day for 5 days.Results Seventy children with acute rotavirus diarrhea wasinvolved in this study. The median duration of diarrhea in thesynbiotic group was 50.0 (SE 1.1); 95%CI 47.9 to 52.1 hours, whilethat of the placebo group was 63.0 (SE 5.9); 95%CI 51.4 to 74.6hours. Based on Kaplan-Meier survival analysis, the duration ofdiarrhea in the synbiotic group was significantly shorter than thatof the placebo group (log-rank test P <0.0001).Conclusion In children with acute rotaviral diarrhea, synbioticreduces the duration of diarrhea compared to placebo.

Risk factors of rotavirus diarrhea in hospitalized children in Sanglah Hospital, Denpasar: a prospective cohort study

BACKGROUND

Diarrhea is a major public health concern throughout the world because the prevalence of morbidity of diarrhea has not changed significantly in the past decade. It remains the third leading cause of death among children less than 5 years of age. Recent surveillance studies have shown that rotavirus is a significant cause of pediatric hospitalization and death due to diarrhea. Indonesia has limited data on risk factors, disease burden, and deaths in children due to rotavirus diarrhea. The objective of this study was to examine the above mentioned factors related to rotavirus diarrhea in hospitalized children in Sanglah Hospital, Denpasar.

METHODS

A prospective cohort study was conducted at Sanglah Hospital Denpasar from April 2009 to December 2011. The present study was part of a nationwide study on Extension for Hospital-based Surveillance and Strain Characterization of Rotavirus Diarrhea Indonesia involving four hospitals throughout Indonesia as a part of the Asian Rotavirus Surveillance Network. We studied children aged <5 years who were hospitalized with acute diarrhea, and analyzed their stool samples using an immunoassay that detects the rotavirus antigen.

RESULTS

A total of 656 patients met the inclusion criteria for this study. Of 5805 patients under the age of 5 who were hospitalized between April 2009 and December 2011, the prevalence of diarrhea among hospitalized pediatric patients was 11.3% and the prevalence of rotavirus diarrhea was 49.8%. The male to female ratio of those affected by rotavirus was 1.6:1. The occurrence of vomiting was significantly higher in rotavirus diarrhea than in non-rotavirus diarrhea (RR, 1.4; 95% CI, 1.08 to 1.70; p = 0.004).

CONCLUSIONS

Diarrhea remains an important cause of hospitalization in children, and rotavirus was the most important etiology. We found that boys had a greatest risk of rotavirus infection than girls. Good nutritional status and breastfeeding provided the same protection against rotavirus and non-rotavirus diarrhea.

Burden of severe rotavirus diarrhea in indonesia

Globally, rotavirus is the leading cause of diarrhea-related hospitalizations and deaths among young children, but the burden of rotavirus disease in Indonesia is poorly documented. From January through December 2006, we conducted prospective surveillance (inpatient and outpatient) among children aged <5 years at 6 hospitals in 6 provinces of Indonesia, using standardized methodology. Of 2240 enrolled children hospitalized for diarrhea, 1345 (60%) were rotavirus positive. Of 176 children enrolled in outpatient clinics in 3 hospitals, 73 (41%) were rotavirus positive. Among children hospitalized for diarrhea, dehydration was more common among those who tested positive for rotavirus than among those who did not (91% vs 82%; P < .05), as was vomiting (86% vs 67%; P < .05). Children aged 6-23 months experienced 72% of all rotavirus episodes. Rotavirus prevalence increased slightly in the cool, dry season. The most commonly detected genotypes were G9 (30%) and P[6] (56%). G1P[6] and G9P[6] accounted for 34% and 21% of strains, respectively. A high proportion of genotype P[6] was detected, in combination with the common G types G1 and G9. Available rotavirus vaccines would likely be efficacious against the most common circulating strains, but continued monitoring of uncommon genotypes is needed.