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Visfatin levels in non-obese, obese, and insulin resistant adolescents Indra Ihsan; Eka Agustia Rini; Rismawati Yaswir
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Adipose tissue is not merely a site for energy storage, but is also the largest endocrine organ, secreting various adipocytokines. Plasma visfatin, an adipocytokine predominantly secreted from visceral adipose tissue, has insulin-mimetic effects, and has been closely linked to insulin resistance.Objective To compare plasma visfatin levels between obese and non-obese adolescents, as well as between obese adolecents with and without insulin resistance.Methods This cross-sectional study was conducted in students who attended three senior high schools in Padang. Subjects comprised 28 obese and 28 non-obese adolescents. The age of the subjects ranged from 14-18 years. Obesity criteria were based on body mass index (BMI) measurements. Fasting serum glucose level was measured by glucose hexokinase photometry and serum insulin was measured by chemiluminesence immunoassay. Plasma visfatin was measured by enzyme-linked immunosorbent assay (ELISA). The insulin resistance index was estimated from fasting serum insulin and glucose levels using the homeostatic model assessment for insulin resistance (HOMA-IR). Differences in the variables were tested using independent T-test and Mann-Whitney test, depending on the distribution of the variables.Results The mean plasma visfatin level was significantly higher in the obese than in the control group [2.55 (SD 1.54) vs. 1.61 (SD 0.64) ng/mL, respectively; (P=0.005)]. The insulin resistant group had significantly higher mean plasma visfatin level than the non-resistant group [3.61 (SD 1.59) vs. 1.96 (SD 1.18) ng/mL, respectively; (P=0.004)].Conclusion Obese adolescents with insulin resistance have signifcantly higher plasma visfatin levels compared to those without insulin resistance.

Delayed diagnosis of congenital hypothyroidism in an adolescent results in avoidable complications: a case report Indra Ihsan; Eka Agustia Rini
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society

Delayed diagnosis of congenital hyporhyroidism (CH) remains a serious problem. A retrospective analysis of 1,000 CH cases in Turkey found a mean age of 49 months at the time of clinical diagnosis. Only 3.1% of cases were diagnosed during the neonatal period and 55.4% were diagnosed after 2 years of age.1 In Cipto Mangunkusumo Hospital, Jakarta, 53% cases were diagnosed at 1-5 years, 3.3% at 6-12 years, and 6.7% after 12 years of age, while the remainder were diagnosed at < 1 year of age.2 The majority of affected children exhibit signs and symptoms that are highly non-specific, as most infants with CH are asymptomatic at birth, and only 5% of cases can be diagnosed based on clinical examination during the first day of life.3 The other factors that contribute to delayed diagnosis are uneducated parents, who do not notice or dismiss the importance of mild/moderate deviations in physical and mental growth, as well as constipation, feeding difficulties, or other vague, non-specific symptoms in infancy. Parents are often unaware of the importance of early diagnosis and commencement of therapy for CH.4

Hubungan status vitamin D dengan mortalitas dan lama rawatan pada anak sakit kritis Nice Rachmawati; Indra Ihsan
Majalah Kedokteran Andalas Vol 40, No 2 (2017): Published in September 2017
Publisher : Faculty of Medicine, Universitas Andalas

Vitamin D memiliki peranan dalam pertahanan tubuh melawan infeksi. Vitamin D menghambat proliferasi sel otot polos vaskuler, melindungi endotel, dan memodulasi proses infeksi. Defisiensi vitamin D akan menyebabkan defek fungsi makrofag seperti kemotaksis, fagositosis, dan produksi sitokin pro-inflamasi. Defisiensi vitamin D akan memberikan luaran yang buruk pada anak sakit kritis. Tujuan: Untuk mengetahui hubungan kadar dan status vitamin D terhadap mortalitas dan lama rawatan pada anak sakit kritis. Metode: Studi potong lintang dilakukan di PICU RSUP M. Djamil Padang sejak Agustus sampai November 2016. Dilakukan penghitungan skor Pelod-2, pemeriksaan kadar serum vitamin D dan kalsium, dan dihubungkan dengan mortalitas serta lama rawatan. Hubungan antar variabel dianalisis statistik menggunakan t-Test, Mann-Whitney, Chi-square dan Kruskal-Wallis. Hasil: Diperoleh prevalensi insufisiensi dan defisiensi vitamin D pada anak sakit kritis adalah 37,50% dan 44,64%. Dari 56 subjek, 19 subjek meninggal dunia (33,92%). Skor Pelod 2 pada awal rawatan berhubungan dengan mortalitas (p=0,001). Tidak terdapat hubungan antara status vitamin D dengan mortalitas (p=0,732) dan lama rawatan (p=0,311) pada anak sakit kritis. Simpulan: Bahwa sebagian besar anak sakit kritis mengalami insufisiensi dan defisiensi vitamin D, namun status vitamin D tidak berhubungan dengan tingkat mortalitas dan lama rawatan.

SARS-CoV-2 Serology Antibody in Children with MIS-C (Multiple Inflammatory Syndrome in Children) Suspected Finny Fitry Yani; Indra Ihsan; Efrida
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 10 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i10.572

Background: Multiple inflammatory syndromes in children (MIS-C) relate to COVID-19 severity in children. SARS-CoV-2 serology antibody is one of the diagnostic tools of MIS-C. The study aimed to describe the yield of serology antibodies of MIS-C and some characteristics found in hospitalized children with MIS-C suspects. Methods: This research was an analytic observational study. The data were collected retrospectively from some children who were hospitalized in Dr. M. Djamil General Hospital, Padang, West Sumatra, Indonesia, from April - June 2021. The inclusion criteria were children aged 1 month to 18 years, with or without contact history with the person who probable or confirmed COVID-19 and have signs and symptoms as MIS-C base on WHO criteria. Results: About eight out of 44 children showed positive serology antibodies and were diagnosed as MISC (18,2%). Based on demographic characteristics, children aged 11-15 years (27.3%) and boys were more affected (52.3%) as MIS-C suspected. Most of them were referred from a 2nd-level hospital outside Padang City (70.4%), but only 13.6% had a history of contact with COVID-19 confirmation patients. There was a significant difference in cardiovascular signs and symptoms between positive and negative serology antibody SARS-CoV-2 among children with MIS-C suspected (p<0.05), but not in fever, respiratory distress, gastrointestinal, neurology symptoms, either in laboratory results such as leukocytes, CRP and D-dimmer. Intravenous immunoglobulin, steroid, and PICU admitted showed no significant differences between the 2 groups, but more death prevalence in positive than negative. However, no significant differences (12.5% vs. 11.1%, p>0.05). Conclusion: Cardiovascular signs and symptoms could be proposed to be one of the significant differences in clinical conditions to differentiated children with MIS-C suspected and MIS-C due to serology antibody results.

Profil Klinis dan Luaran Syok Sepsis pada Pasien Anak yang Dirawat di PICU RSUP Dr. M. Djamil Padang Yoga Gandha Prasetya; Indra Ihsan; Amirah Zatil Izzah
Jurnal Ilmu Kesehatan Indonesia Vol 1 No 3 (2020): November 2020
Publisher : Fakultas Kedokteran, Universitas Andalas

Background. Septic shock is a common pediatric emergency with a high mortality rate. Objective. The purpose of this study was to determine the clinical profile and outcome of septic shock in pediatric patients treated at PICU of DR. M. Djamil Padang State General Hospital. Method. This descriptive study used data from medical records, conducted in the Medical Record Department of DR. M. Djamil Padang State General Hospital. The target population was pediatric patients which was diagnosed with septic shock in PICU through 2015 - 2017. Samples were collected by the total sampling technique. Result. During the following study of ninety-one patients septic and forty-eight having septic shock. Children having septic shock were commonly under one year of age, female, low nutritional status, having central neuron system infection of Klebsiella sp, having less than two organ dysfunctions with clinical manifestations of Hyperthermia, Tachycardia, and Tachypnea. Hematological profile found that patients commonly had anemia, leukocytosis, thrombocytopenia, and normal I/T ratio. Shock septic outcomes were found high mortality rate, almost some patients use a ventilator, high inotropic usage, and length of stay in living patients compared to dead. Conclusion. The study concluded that prevalence Septic Shock pediatric still high with higher mortality and also morbidity

SARS-CoV-2 Serology Antibody in Children with MIS-C (Multiple Inflammatory Syndrome in Children) Suspected Finny Fitry Yani; Indra Ihsan; Efrida
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 10 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i10.572

Background: Multiple inflammatory syndromes in children (MIS-C) relate to COVID-19 severity in children. SARS-CoV-2 serology antibody is one of the diagnostic tools of MIS-C. The study aimed to describe the yield of serology antibodies of MIS-C and some characteristics found in hospitalized children with MIS-C suspects. Methods: This research was an analytic observational study. The data were collected retrospectively from some children who were hospitalized in Dr. M. Djamil General Hospital, Padang, West Sumatra, Indonesia, from April - June 2021. The inclusion criteria were children aged 1 month to 18 years, with or without contact history with the person who probable or confirmed COVID-19 and have signs and symptoms as MIS-C base on WHO criteria. Results: About eight out of 44 children showed positive serology antibodies and were diagnosed as MISC (18,2%). Based on demographic characteristics, children aged 11-15 years (27.3%) and boys were more affected (52.3%) as MIS-C suspected. Most of them were referred from a 2nd-level hospital outside Padang City (70.4%), but only 13.6% had a history of contact with COVID-19 confirmation patients. There was a significant difference in cardiovascular signs and symptoms between positive and negative serology antibody SARS-CoV-2 among children with MIS-C suspected (p<0.05), but not in fever, respiratory distress, gastrointestinal, neurology symptoms, either in laboratory results such as leukocytes, CRP and D-dimmer. Intravenous immunoglobulin, steroid, and PICU admitted showed no significant differences between the 2 groups, but more death prevalence in positive than negative. However, no significant differences (12.5% vs. 11.1%, p>0.05). Conclusion: Cardiovascular signs and symptoms could be proposed to be one of the significant differences in clinical conditions to differentiated children with MIS-C suspected and MIS-C due to serology antibody results.

Pengaruh Probiotik terhadap Kadar Calprotectin Feses dan Durasi Diare Akut pada Anak Idha Yulfiwanti; Yusri Dianne Jurnalis; Asrawati Asrawati; Iskandar Syarif; Rinang Mariko; Amirah Zatil Izzah; Indra Ihsan
Sari Pediatri Vol 26, No 2 (2024)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.2.2024.74-9

Latar belakang. Probiotik adalah mikroorganisme yang menguntungkan dalam pengobatan diare akut pada anak. Probiotik mengurangi frekuensi dan durasi diare dengan meningkatkan respon imun, produksi substansi antimikroba, menurunkan proses inflamasi, dan menghambat pertumbuhan kuman patogen penyebab diare. Pengukuran calprotectin feses sebagai penanda penyakit inflamasi pada diare akut merupakan metode noninvasif, cepat dan mudah.Tujuan. Penelitian ini bertujuan untuk mengetahui pengaruh probiotik terhadap kadar calprotectin feses dan durasi diare akut pada anak.Metode. Penelitian eksperimental dengan pendekatan pretest-posttest control group yang dilaksanakan di Puskesmas dan Rumah Sakit di kota Padang. Penelitian dimulai dari bulan Januari sampai Juni 2023. Populasi penelitian adalah pasien anak usia 2-60 bulan dengan diare akut yang memenuhi kriteria inklusi dan ekslusi. Terdapat 31 sampel kelompok kontrol yang mendapatkan terapi standar WHO dan 30 sampel kelompok kasus yang mendapatkan terapi standar WHO ditambah probiotik. Dilakukan pengamatan terhadap durasi diare akut dan kadar calprotectin feses.Hasil. Anak dengan usia >24 bulan lebih banyak pada kedua kelompok dengan sebagian besar kelompok dengan gizi baik. Rerata berat badan dan tinggi badan subjek pada kelompok kasus adalah 10,76 kg dan 82,6 cm, sedangkan kelompok kontrol adalah 10,15 kg dan 81 cm. Terdapat pemendekan durasi diare yang signifikan pada kelompok kasus dibandingkan kelompok kontrol adalah 10,32 (+6,35)jam (p-value =0,049). Terdapat perbedaan kadar calprotectin feses yang signifikan antara sebelum dan sesudah pemberian probiotik pada kelompok kasus (p-value =0,038).Kesimpulan. Pemberian probiotik dapat memperpendek rerata durasi diare akut dan menurunkan rerata kadar calprotectin feses secara bermakna. Pemberian probiotik ini dapat disarankan sebagai terapi adjuvan dalam tata laksana diare akut pada anak.

Differences in Mean Anti-Pertussis Antibody Levels in Children with Acellular Pertussis Immunization and Whole Pertussis Without Booster Wenny Rahmalia Rezki; Rinang Mariko; Rizanda Machmud; Rusdi; Asrawati; Indra Ihsan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 7 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i7.1022

Background: The incidence of pertussis is increasing every year, especially in developing countries. Low immunization coverage and decreased immunity are some of the factors causing the re-increase in pertussis cases. The protection provided by the pertussis vaccine whole and acellular pertussis given as a baby will decrease with age. This study aims to determine the difference in mean levels of anti-pertussis antibodies in children who received acellular pertussis and whole pertussis immunization without a booster. Methods: A cross-sectional study was carried out at the pediatric polyclinic of Dr. M. Djamil General Hospital Padang from December 2022 to December 2023. Research subjects were children aged 5-9 years with a history of whole pertussis immunization (DPwT) 3 times or acellular pertussis immunization (DPaT) 3 times. The research subjects were examined for anti-pertussis antibody titers using the ELISA technique. Results: Thirty-four children with a history of DPwT immunization 3 times and 34 children with a history of DPwT immunization 3 times were research subjects, with mean age 6.94±1.49 in the DPwT group and 6.88 ±1.61 in the DPaT group. The mean anti-pertussis antibody level in the DPwT group (9.54 IU/mL) was higher than the DPaT group (6.96 IU/mL) but was not statistically significant (p>0.05). The average antibody results showed that the antibody levels in both groups were below the antibody titer threshold that provides protection against pertussis. The results of the analysis showed that there was a significant difference in the incidence of AEFI between the DPwT and DPaT immunization groups (p<0.05). Conclusion: There was no difference in anti-pertussis antibody levels in children who received DPwT and DPaT immunization 3 times. Pertussis immunization is a required booster so that antibody levels are sufficient to provide protection against pertussis.

Shock Management and Hemodynamic Monitoring of Severe Dengue with Fluid Overload: A Case Report Shinta Asbi; Indra Ihsan; Rinang Mariko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 11 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i11.1105

Background: Dengue shock syndrome (DSS) is a life-threatening complication of dengue infection characterized by plasma leakage, shock, and organ dysfunction. Fluid management is crucial in DSS, but fluid overload can lead to adverse outcomes. This case report highlights the challenges and strategies in managing DSS with fluid overload. Case presentation: An 8-year-old girl presented with severe dengue, DSS, encephalopathy, and fluid overload. She had a history of high fever, vomiting, and altered consciousness. Initial management focused on fluid resuscitation, but the patient developed signs of fluid overload. Hemodynamic monitoring using USCOM (Ultrasonic Cardiac Output Monitor) revealed low cardiac output and high systemic vascular resistance. Fluid restriction and inotropic support with epinephrine were initiated. The patient's condition gradually improved, and she was discharged after complete recovery. Conclusion: This case emphasizes the importance of early recognition and careful monitoring of fluid status in DSS. Hemodynamic monitoring tools like USCOM can aid in guiding fluid management and identifying complications like fluid overload. Prompt intervention with fluid restriction and inotropic support can improve outcomes in DSS patients with fluid overload.

Shock Management and Hemodynamic Monitoring of Severe Dengue with Fluid Overload: A Case Report Shinta Asbi; Indra Ihsan; Rinang Mariko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 11 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i11.1105

Background: Dengue shock syndrome (DSS) is a life-threatening complication of dengue infection characterized by plasma leakage, shock, and organ dysfunction. Fluid management is crucial in DSS, but fluid overload can lead to adverse outcomes. This case report highlights the challenges and strategies in managing DSS with fluid overload. Case presentation: An 8-year-old girl presented with severe dengue, DSS, encephalopathy, and fluid overload. She had a history of high fever, vomiting, and altered consciousness. Initial management focused on fluid resuscitation, but the patient developed signs of fluid overload. Hemodynamic monitoring using USCOM (Ultrasonic Cardiac Output Monitor) revealed low cardiac output and high systemic vascular resistance. Fluid restriction and inotropic support with epinephrine were initiated. The patient's condition gradually improved, and she was discharged after complete recovery. Conclusion: This case emphasizes the importance of early recognition and careful monitoring of fluid status in DSS. Hemodynamic monitoring tools like USCOM can aid in guiding fluid management and identifying complications like fluid overload. Prompt intervention with fluid restriction and inotropic support can improve outcomes in DSS patients with fluid overload.

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