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B. N. P. Arhana
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Journal : Paediatrica Indonesiana

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Plasma prothrombin time and activated partial thromboplastin time as predictors of bleeding manifestations during dengue hemorrhagic fever I. N. Budastra; B. N. P. Arhana; IB. Mudita
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (114.652 KB) | DOI: 10.14238/pi49.2.2009.69-74

Abstract

Background  Massive bleeding and shock are complications  ofdengue  hemorrhagic  fever (DHF)  that  are associated withhigh mortality. Impaired hemostasis, especially coagulopathy,contributes  to  bleeding manifestations in DHF. Parameters suchas  activated partial thromboplastin time (APTT)  and  plasmaprothrombin  time (PPT) indicate  the  impact  of  coagulationsystem.Objective  To  determine the relationship between  APTT  and PPTlevels with bleeding manifestations in  DHF  patients.Methods  A prospective  cohort  study was applied to subjectsdiagnosed with  DHF  at  the  Infection  and  Tropical DiseasesDivision, Department  of  Child Health, Medical School, UdayanaUniversity, Sanglah Hospital, Denpasar, Indonesia. Laboratorytests  to  determine  APTT  and  PPT  were carried  out  on  thethird, fourth,  and  fifth day after  the  onset  of  fever. Bleedingmanifestations were examined in patients during their hospitalstay. Univariate  and  Cox regression analyses were performedto examine relationship between  APTT  and  PPT  values withbleeding manifestations in  DHF  patients.Results  Forty-three children were enrolled in this study.  Therewas a significant relationship between increases in  APTT  valuewith bleeding manifestations in  DHF  patients [RR 2.79 (95%CI1.68 to 4.69), P <0.01]. Cox regression analysis showed  that  onlyincreased  APTT  values correlated with bleeding manifestations[RR 2.05 (95%CI 1.92 to 3.90), P  =  0.02].Conclusion  APTT  values may be used  as  a predictor for bleedingmanifestations  in  DHF.
The role of zinc supplementation in humoral immune response to hepatitis B vaccination in infants: a double-blind randomized placebo-controlled trial K. Suarca; Hendra S; B. N. P. Arhana; I K. G. Suandi
Paediatrica Indonesiana Vol 48 No 6 (2008): November 2008
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (128.043 KB) | DOI: 10.14238/pi48.6.2008.374-80

Abstract

Background Suboptimal zinc intake may depress thymus function,lymphoproliferation, and T cell-dependent B-cell proliferation,which can impair antibody production. Zinc supplementation canimprove immune function and reduce morbidity.Objective To assess the effect of zinc supplementation on infants'anti-HBs titer after hepatitis B vaccination.Methods A double-blind randomized control trial of 66 healthyinfants in Pustu Dauh Puri, Denpasar Barat was conducted. Subjectswere followed from birth to three months of age and were placedinto two treatment groups using block randomization. One groupreceived zinc supplements with a standard hepatitis B vaccination(zinc group, n=33) and the other group received placebosupplements with standard hepatitis B vaccination (placebo group,n=33). The serum zinc levels were measured at baseline and atthree months. The difference in levels of anti-HBs titer between thezinc and placebo groups was the primary endpoint of this study.Results The serum zinc levels were significantly higher in the zincgroup compared to the placebo group (P = 0.017), with a meandifference of 18.76 miU/ml (95% CI 3.45 to 34.07). Regardlessof baseline serum zinc levels, the mean anti-HBs titers weresignificantly higher in the zinc group compared to the placebogroup (P <0.0001; mean difference = 495.8 miU/mL; 95%CI 362.32 to 629.44). Multivariate analysis showed that zincsupplementation was the only variable that influenced anti-HBstiter levels (P < 0.0001).Conclusion Regardless of their initial zinc serum level, infantsreceiving zinc supplements along with standard hepatitis Bvaccination have significantly higher levels of anti-HBs titersthan infants receiving hepatitis B vaccination without zincsupplements.
Co-Authors Hendra S I K. G. Suandi I. N. Budastra IB. Mudita K. Suarca