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Paediatrica Indonesiana
ISSN : 00309311     EISSN : 2338476X     DOI : -
Core Subject : Health,
Paediatrica Indonesiana is a medical journal devoted to the health, in a broad sense, affecting fetuses, infants, children, and adolescents, belonged to the Indonesian Pediatric Society. Its publications are directed to pediatricians and other medical practitioners or researchers at all levels of health practice throughout the world.
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Articles 9 Documents
Search results for , issue "Vol 60 No 3 (2020): May 2020" : 9 Documents clear
PEDIATRIC INFECTIVE ENDOCARDITIS INITIALLY PRESENTING AS HEMORRHAGIC STROKE Yonas, Emir; Pranata, Raymond; Damay, Vito; Nusarintowati, Nuvi
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

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Abstract

Infective endocarditis refers to infection of the heart valves. While its incidence is low, it may cause serious complications. Despite advances in its management and diagnosis, this condition still retains high mortality and significant morbidity. Considerable controversy remains regarding antimicrobial prophylaxis to prevent infective endocarditis in patients with congenital heart disease. Neurologic complications are the second most common complication in patients with infective endocarditis, occurring in approximately 33% of cases.1 These include encephalopathy, meningitis, stroke, brain abscess, cerebral hemorrhage, and seizures. The vegetation formed as a consequence of endocarditis may dislodge and cause embolization. Vegetation size alone is an unreliable marker for embolization risk, however, size, in addition to location, mobility, infecting agent, and presence of antiphospholipid antibodies have the potential to be prognostic markers. The brain is the most frequent site of embolization. Furthermore, advances in medical approaches have resulted in an increase of patients at risk of endocarditis due to the now common and widely available indwelling intravascular approaches in medicine. In this report, we present a case of infective endocarditis in a child first presenting with hemorrhagic stroke.1,2
OUVRIER’S MODIFIED MINI MENTAL STATE EXAMINATION AS A SCREENING TEST FOR COGNITIVE IMPAIRMENT IN SCHOOL-AGED CHILDREN WITH EPILEPSY Saputra, Hariadi Edi; Handryastuti, Setyo; Mangunatmadja, Irawan; Widodo, Dwi Putro; Pardede, Sudung O.
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Epilepsy may affect children's development, including their cognitive function. The prevalence of cognitive impairment in epilepsy patients is quite high. Weschler Intelligence Scale for Children (WISC) takes a long time to administer and is expensive, so a simpler screening tool for cognitive evaluation is needed in pediatric epilepsy patients. Objective To assess the diagnostic value of Ouvrier?s Modified Mini Mental State Examination (MMSE) for detecting cognitive impairment in children aged 8-11 years with epilepsy. Methods This diagnostic study was conducted in December 2018 to February 2019 at Cipto Mangunkusumo and Fatmawati Hospitals in Jakarta. Data were collected with purposive sampling of children with epilepsy aged 8 to 11 years. Cognitive function was assessed by Ouvrier?s Modified MMSE and WISC. Ouvrier?s Modified MMSE was compared to WISC as and the gold standard. Results were analyzed using a 2x2 table. Results The prevalence of cognitive impairment in 8-11-year-old epilepsy patients was 72.9%. Ouvrier?s Modified MMSE had 83% sensitivity, 85% specificity, 94% positive predictive value, 65% negative predictive value, and 83% accuracy. Conclusions Ouvrier?s Modified MMSE has good diagnostic value, thus it may be useful for early detection of cognitive impairment in pediatric epilepsy.
REDUCED LEVELS OF CIRCULATING NATURAL KILLER CELLS IN CHILDREN WITH CELIAC DISEASE Agin, Mehmet; Sevinc, Eylem; Dogan, Erkan; Sevinc, Nergiz
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Celiac disease (CD) is an autoimmune disease characterized by malabsorption. Serologic testing for CD consists of Ig A type of antitissue transglutaminase (tTG), antiendomysium (EMA). These tests are helpful in monitoring adherence to the gluten-free diet (GFD). Natural killer (NK) cell count alterations have been reported in various diseases, such as cancer, Crohn?s disease, malnutrition, and autoimmune disorders. Objective To compare peripheral blood NK cell counts in children with celiac disease (CD) to healthy controls. The second aim was to analyze for possible correlations between NK cells (CD3-/CD16+, CD56+) and tissue transglutaminase (tTG)-IgA and tTG-IgG, as well as endomysial antibody EMA-IgA indicating gluten sensitivity. Methods Fifty children with CD were compared to 48 healthy children as controls, with similar age and sex distribution. Peripheral blood NK cell counts were measured by flow cytometry. Results The median (P25-P75) ages of the 50 celiac patients (23 male; 46%) and 48 controls (21 male; 44%) were 10 (2-17) years and 9 (3-17) years, respectively. Mean follow-up duration was 3 years, ranging from 1-10 years. All CD patients had positive tTG-IgA and EMA-IgA tests while it was negative in all (100 %) control patients. The absolute number of circulating CD16+ NK cells (259.52 vs. 1404.36 ?/L) and CD56+ NK cells (366.24 vs. 2440.46 ?/L) were significantly lower in the celiac group than the control group (P<0.05 for both). The absolute numbers of circulating white blood cells (7785 vs. 8165 ?/L) and lymphocytes (3106 vs. 3173 ?/L) were not significantly different between the celiac and control groups (P>0.05 for both). Correlation analysis between the absolute number of circulating NK cells and tTG-IgA, tTG-IgG, and EMA-IgA levels in CD patients revealed no significant relationships (P>0.05 for all). Conclusions Peripheral blood NK cell count were significantly lower in celiac patients than controls, hence, decreased NK cell counts may be an abnormal feature seen in autoimmune diseases. NK cell count in celiac patients had no significant correlations to tTG-IgA, tTG-IgG, or EMA-IgA levels. Therefore,  NK cell count  may be inappropriate marker for monitoring compliance to a gluten free diet.
EFFICACY OF HIGH-DOSE METHYLPREDNISOLONE AND CYCLOPHOSPHAMIDE IN CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS Trisnia, Putu Ayunda; KUmara Wati, Ketut Dewi; Witarini, Komang Ayu; Sutawan, Ida Bagus Ramajaya; Santoso, Hendra
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease. Untreated SLE often become progressive and lead to increased risk of mortality. Corticosteroid and cyclophosphamide remain the treatment of choice for severe SLE. Disease activity assessed with SLE Daily Activity Index (SLEDAI). Objective To compare the disease activity of childhood-onset severe SLE at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide by using  SLEDAI. Methods This study was conducted in the Division of Pediatric Allergy and Immunology, Department of Child Health, Udayana University/Sanglah Hospital, Denpasar, Bali. Subjects were SLE patient aged 0-18 years who had severe clinical manifestations. Subject received therapy combination of high dose methylprednisolone and cyclophosphamide every 2 weeks for six doses. SLEDAI score was assessed at the time of diagnosis, after completion of high dose methylprednisolone, and after three month of cyclophosphamide. Results During the study period, 51 children were diagnosed as SLE. Twenty-one subjects were included for analysis. Median SLEDAI score at the time of diagnosis was 23 (range 13-39). SLEDAI score after three months of cyclophosphamide was decreased to 2 (range 0-14). Post hoc analysis with Wilcoxon signed-rank test showed the improvement of SLEDAI score at the time of diagnosis and after three months of cyclophosphamide was statistically significant  (Z=-4.016, P<0.0001). Conclusion SLEDAI score reduced after completion of high-dose methylprednisolone and three month of cyclophosphamide therapy.
VALIDATION OF THE INDONESIAN VERSION OF MODIFIED CHECKLIST FOR AUTISM IN TODDLERS: A DIAGNOSTIC STUDY Salim, Hendra; Soetjiningsih, Soetjiningsih; Windiani, I Gusti Ayu Trisna; Widiana, I Gede Raka; ASPR, PITIKA
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Autism is a developmental disorder for which early detection in toddlers is recommended because of its increased prevalence. The Modified Checklist for Autism in Toddlers (M-CHAT) is an easy-to-interprete tool that can be filled out by parents. It has been translated into the Indonesian language but needs to be validated. Objective To evaluate the diagnostic validity of the Indonesian version of M-CHAT in detection of autism spectrum disorder in Indonesia. Methods A diagnostic study was conducted at Sanglah Hospital, Denpasar, Bali, from March 2011 to August 2013. Pediatric outpatients aged 18 to 48 months were included. The Indonesian version of the M-CHAT tool was filled by parents. Autism assessment was done according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR). The assessment results were analyzed with the MedCalc program  software, in several steps: (i) reliability of M-CHAT; (ii) description, distribution, and proportion to determine the characteristics of the subjects of research; and (iii) validity of M-CHAT compared to the gold standard DSM-IV-TR by a receiver operating characteristic curve and several area under the curve cut-off points, in order to assess the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio, accompanied by the 95% confidence interval of each value. Results The Indonesian version of M-CHAT in toddlers had 82.35% sensitivity and 89.68% specificity, using the cut-off point of more than 6 failed questions. Conclusion The Indonesian version M-CHAT translated by Soetjiningsih has optimal diagnostic validity for detection of autism in toddlers.
PARENTAL KNOWLEDGE, ATTITUDE, AND BEHAVIORAL FACTORS IN IMMUNIZATION RESPONSE FOLLOWING A DIPHTHERIA OUTBREAK IN CHILDREN IN 2018-2019 Arfimita, Nabila; Surjono, Edward
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background A diphtheria outbreak was declared at the end of 2017. The outbreak response immunization (ORI) was a key Indonesian government strategy to control diphtheria in three outbreak areas. This strategy was implemented starting December 11, 2018.  Parents? positive knowledge, attitude, and behavior regarding diphtheria and the diphtheria ORI may influence the coverage of diphtheria ORI in Indonesia. Objective To assess for relationships between parental knowledge, attitude, and behavior to coverage of diphtheria ORI in children.  Method This cross-sectional study was conducted at Kapuk Muara Public Elementary School 03, North Jakarta from November 2018 to August 2019. The respondents were parents of the schoolchildren. Parents filled questionnaires about their knowledge, attitude, and behavior with regards to diphtheria ORI coverage in children. Results The coverage of diphtheria ORI in children was 61.8%. From 110 respondents, 40.9% of parents had at least sufficient knowledge, 73.8% had good attitude, and 55.5% had good behavior regarding diphtheria and diphtheria ORI. Parental knowledge had no significant association to coverage of diphtheria ORI in their children. However, there were significant relationships between parental attitude and behavior to coverage of diphtheria ORI in their children. Conclusion The coverage of diphtheria ORI needs improvement. Most parents have sufficient level of knowledge, good attitude, and good behavior towards diphtheria and diphtheria ORI. There is no association between parental knowledge about diphtheria and diphtheria ORI to coverage of diphtheria ORI, but there are significant association of parental attitude and behavior toward diphtheria ORI coverage.
ASSOCIATION OF BMI MEASUREMENTS TO WAIST CIRCUMFERENCE AND WAIST-TO-HEIGHT RATIO IN OVERWEIGHT AND OBESE CHILDREN Irenewati, Sindy; Arkhaesi, Nahwa; Wistiani, Wistiani
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Early monitoring of visceral fat is important to prevent the worsening of obesity in children. In recent years, waist circumference (WC) and waist-to-height ratio (WHtR) measurements have gained attention as an anthropometric indexes for obesity in children. They are an easy-to-use, inexpensive, specific to visceral fat and safe monitoring methods for children. International reference values, however, do not exist for any of the two measures to determine obesity in children. Objective To compare WC and WHtR to body mass index (BMI) status in overweight and obese children aged 10-12 years. Methods This cross-sectional study included overweight and obese children aged 10-12 years from four  primary schools in Semarang, Central Java.  Subjects underwent anthropometric measurements including weight, height, and waist circumference. Subjects were classified as obese (?P95) or overweight (P85?P<P95) using BMI percentiles according to age and sex. Chi-square test was used to assess for associations between categorical variables and multivariate logistic regression analysis was used to identify a dominant variable. Results Forty-two obese and 23 overweight children were studied. Children with higher values of WC (PR=1.879) and WHtR (PR=8.352) had a higher prevalence of having higher BMI status (obese). Using multivariate analysis, WHtR was the more dominant variable associated with BMI status, compared to WC. Conclusion Higher WC (cut off P90) and WHtR (cut off 0.5) have a significant associations with greater obesity children aged 10-12 years. Compared to WC, WHtR is a stronger predictive factor for obesity.
INFLUENCE OF SCREEN TIME AND SLEEP DURATION ON OBESITY IN EARLY ADOLESCENTS Malik, Shafira Maharani; Rahmadi, Farid Agung; Wistiani, Wistiani
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Behavioral and environmental factors increase the risk of obesity. Many Indonesian children have their own smartphones and engage in excessive screen time, which may negatively impact their nutritional status and sleep duration. However, to our knowledge no studies have explained the magnitude of the influence of screen time and sleep duration on obesity in early adolescents. Objective To analyze the influence of screen time and sleep duration on obesity in children aged 10-13 years. Methods This case-control study was done from April to June 2019 in Semarang, Central Java. Subjects comprised 70 obese and 70 non-obese children, based on CDC body mass index-for-age percentiles. Subjects were recruited from 7 primary schools. Children?s screen time and sleep duration data were collected from the modified 3DPAR questionnaire. Statistical analysis was conducted using Chi-square and logistic regression tests. Results Obesity had significant associations with short sleep duration (aOR=4.20; 95%CI 1.80 to 9.78) and long computer screen time (OR=4.13; 95%CI 1.28 to 13.25). Total screen time on other media or all media combined were not associated with obesity since both the obese and non-obese groups spent >2 hours/day on screens. Short sleep duration was the dominant risk factor for obesity (OR=4.08; 95%CI 1.78 to 9.35). Conclusion Short sleep duration (<9 hours/day) is associated with and a dominant risk factor for obesity in children aged 10-13 years. However, screen time is not associated and not influential as a dominant risk factor for obesity, despite the high odds of obesity in children with long computer screen time (>2 hours/day).
IMPACT OF ALBUMIN LEVELS ON CLINICAL OUTCOMES IN CHILDREN UNDERWENT ABDOMINAL SURGERY Dewi, Rismala; Silitonga, Freddy Guntur Mangapul; Mangunatmadja, Irawan
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

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Abstract

Background Patients underwent abdominal surgery and had hypoalbuminemia were at risk of post-operative complications. The prognostic role of albumin levels in children with abdominal surgery remains unclear. Objective To investigate the impact of albumin levels on clinical outcomes related to the complications in children with abdominal surgery. Methods This was a retrospective cohort study on children aged 29 days to 18 years, who underwent abdominal surgery, had serum albumin levels measured at pre-operative and within 48 hours post-operatively, and hospitalized in Paediatric Intensive Care Unit of Dr. Cipto Mangunkusumo Hospital, Indonesia. The primary outcomes were post-operative complications (sepsis, surgical site infection, shock), length of stay in PICU, dehiscence, relaparotomy, and postoperative mortality. Results This study recruited a total of 201 children. Pre- and post-operative serum albumin levels of ? 3.00 g/dL were found in 15.4% and 51.2%, respectively. Pre- and post-operative serum albumin levels of ? 3.00 g/dL were associated with higher risk of post-operative sepsis (RR 3.4; 95%CI 1.54 to 7.51) and relaparotomy (RR 3.84; 95%CI 1.28 to 1.49). The median of length of PICU stay was 4 days longer in children with pre-operative serum albumin levels ? 3.00 g/dL (P<0.001). Conclusions Hypoalbuminemia condition in children undergo abdominal surgery is associated with increased risk of post-operative sepsis, longer length of stay in PICU, and risk of relaparotomy.

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