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Efficacy of artemether-lumefantrine and artesunate-amodiaquine for treating uncomplicated falciparum malaria in children Tri Faranita; Ayodhia Pitaloka Pasaribu; Muhammad Ali; Munar Lubis; Syahril Pasaribu
Paediatrica Indonesiana Vol 52 No 5 (2012): September 2012
Publisher : Indonesian Pediatric Society

Background Artesunate-amodiaquine (ASAQ) has been usedas a firsdine treatment for uncomplicated faldparum malariain Indonesia since 2004. Its efficacy depends on amodiaquineresistance of the infecting parasites. Artemether-lumefantrine(AL) has been shown to be highly efficacious in treatinguncomplicated faldparum malaria in several countries. However,there have been few studies on these anti-malarial medicationsin Indonesia.Objective To compare the efficacy of AL to ASAQ for treatinguncomplicated faldparum malaria in children.Methods An open, randomized, controlled trial wasconducted in school-aged children in the Mandailing NatalRegency, North Sumatera Province, Indonesia, from Octoberto December 2010. A total of 280 pediatric, uncomplicatedfalciparum malaria patients were randomly assigned to receiveeither AL or ASAQ for 3 days. Participants were followed-up ondays 1,2,3,7, 14, 28 and 42 following the first medication dose.The outcomes noted were adequate clinical and parasitologicalresponse (ACPR), parasite reduction, parasite clearance time,fever clearance time and adverse events. Analysis was basedon intention-to-treat.Results In this study, ACPRs on day 42 were 86.4% and 90.7%for the ASAQ and AL groups, respectively (p=0.260). On days 7and 14, the AL group had higher cure rates than that of the ASAQgroup (P<0.05). Early treatment failure, late treatment failure andparasitological failure for both groups were similar. We also foundfaster parasite clearance time and higher parasite reduction in theAL group than in the ASAQ group. However, fever clearancetime was shorter in the ASAQ group. The incidence of adverseevents such as nausea, vomiting, malaise, and pruritus were similarbetween the two groups (P=0.441).Conclusion AL had higher efficacy than ASAQ for the treatment of uncomplicated falciparum malaria in children.[Paediatr rndones. 2012;52:260-6].

Effectiveness of phototherapy with reflecting curtains on neonatal jaundice Ari Kurniasih; Guslihan Dasa Tjipta; Muhammad Ali; Emil Azlin; Pertin Sianturi
Paediatrica Indonesiana Vol 51 No 5 (2011): September 2011
Publisher : Indonesian Pediatric Society

Background Although phototherapy has been used in clinical practice for 40 years, there is still much debate on how to provide the most efficacious phototherapy. Phototherapy with white reflecting curtains may increase the average spectral irradiance provided, as well as decrease serum bilirubin concentrations at a faster rate in neonates with jaundice.Objective To determine if adding low cost, white, reflecting curtains to a standard phototherapy unit can increase the effectiveness of phototherapy for neonatal jaundice.Methods A randomized, controlled, open trial was conducted at H. Adam Malik and Pirngadi Hospitals, Medan, from May to December 2009. The criteria for inclusion in the study were full term newborns with neonatal jaundice presenting in their first week of life. Single phototherapy with white curtains hanging from the sides of the phototherapy unit (study group, n=30) was compared to single phototherapy without curtains (control group, n=30). The primary outcomes measured were the mean difference in total serum bilirubin levels and average spectral irradiation levels measured at baseline, and after 12 hours and 24 hours of phototherapy.Results The sum of average spectral irradiance in the curtained phototherapy unit was significantly higher than that of the standard phototherapy unit without curtains (P < 0.05). The decrease of total serum bilirubin levels after 12 and 24 hours of phototherapy was significantly greater in the study group (3.71 and 9.7 mg/dl, respectively) than in the control group (0.1 and 3.8 mg/dl, respectively), both P <0.05.Conclusion White, reflecting curtains in phototherapy units was significantly more effective than phototherapy without curtains for treatment of neonatal jaundice. [Paediatr Indones. 2011;51:256-61].

Quality of life assessment of children with thalassemia Masyitah Sri Wahyuni; Muhammad Ali; Nelly Rosdiana; Bidasari Lubis
Paediatrica Indonesiana Vol 51 No 3 (2011): May 2011
Publisher : Indonesian Pediatric Society

Background Thalassemia is a chronic disease that is becoming aÂ major health problem in the world, including the Mediterranean,Â as well as Malaysia, Thailand and Indonesia. This condition clearlyÂ affects the patient's quality of life, because of the condition itself andthe effects of treatment. Assessment is needed to detennine actionsÂ to be taken to improve the quality of life in thalassemic children.Objective To assess the differences in quality of life of thalassemicÂ children compared to their normal siblings.Methods We perfonned a crossô€Œsectional study from May 2010Â until June 2010 in H. Adam Malik Hospital, Medan and the homeÂ of a member of the North Sumatra Chapter of the Association ofÂ Parents of Thalassemia Sufferers (perhimpunan Orangtua PenderitaTalasemia Indonesia, POPTI). Thalassemic children aged 5-18Â years and their age and genderô€Œadjusted siblings were divided intoÂ two groups: case group and control group. Parents and childrenÂ were asked to fill the PedsQL (Pediatric Quality of life Inventory)version 4.0 questionnaire to assess their quality of life.Results There were 59 children in each group. The assessments ofÂ four quality of life domains in the thalassemic group vs the controlÂ group showed the folloMng: physical function 53.1 vs 71.5 (95%Â CI -21.41 to -15.26, Pô€O.OOOI), emotional function 50.9 vs 62.9Â (95% CI -16.82 to -7 .41, Pô€O.OOO 1), social function 62.5 vs 72.8Â (95% CI-13.50 to -7.01, Pô€O.OOOI) and school function 36.2 vsÂ 56.0 (95% CI -22.95 to -16.71, Pô€O.OOOI). Total scores were 50.9Â vs 66.1 (95% CI -18.20to -13.12, Pô€O.OOOI). School function wasÂ the most affected parameter studied, with thalassemic childrenÂ scoring lower than the control group.Conclusion There were significant decreases in the quality ofÂ life parameters in the thalassemic group compared to the controlÂ group. Thalassemic children have poorer quality oflife comparedÂ to their nonnal siblings, Mth school function being the mostaffected domain.Â

Effectiveness of single and double phototherapy on indirect hyperbilirubinemia in neonates Nanda Susanti Milyana; Guslihan Dasa Tjipta; Muhammad Ali; Emil Azlin; Bugis Mardina Lubis; Pertin Sianturi; Bebi Sofiani Hasibuan
Paediatrica Indonesiana Vol 51 No 6 (2011): November 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.6.2011.316-21

Background Hyperbilirubinemia is a common problem in full term newborns and phototherapy is the most widespread treatment for lowering bilirubin concentration in neonates. Double phototherapy could increase the effectiveness of treatment.Objective To compare the effectiveness of single and double phototherapy and increasing spectral irradiance for decreasing serum bilirubin levels in neonates for indirect hyperbilirubinemia.Methods An open, randomized, controlled trial was conducted at H. Adam Malik and Pirngadi Hospitals, Medan, from May to December 2009. Subjects were divided into two groups, those who received single phototherapy (n=30) and those who received double phototherapy (n=30) treatments. We included term newborns with neonatal jaundice in the first week of life. Serum bilirubin and average spectral irradiation levels were measured at baseline and after 12 hours and 24 hours of phototherapy treatment.Results The mean total bilirubin levels of the single and double phototherapy groups at the beginning of therapy were 17.6 mg/dL (SD1.41) and 17.5 mg/dL (SD 1.32), respectively, with no significant difference between values. During the study period the sum of average spectral irradiance by double phototherapy was significantly higher than that of single phototherapy (P < 0.05). A significantly greater decrease in bilirubin levels was observed in the double phototherapy group at 12 hours and 24 hours of phototherapy compared to the single phototherapy group (P = 0.001).Conclusion Double phototherapy is more effective than single phototherapy in reducing bilirubin levels in jaundiced newborns.

Decreased peak expiratory flow in pediatric passive smokers Fitri Yanti; Muhammad Ali; Ridwan M. Daulay; Wisman Dalimunthe; Rini Savitri Daulay
Paediatrica Indonesiana Vol 51 No 4 (2011): July 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.4.2011.198-201

Background Indonesia ranks fifth among countries with the highest aggregate levels of tobacco consumption in the world. Infants and children exposed to environmental tobacco smoke have increased rates of asthma, respiratory and ear infections, as well as reduced lung function. The effects of tobacco smoke exposure on lung function in children have been reported to be dependent on the source of smoke and the length and dose of exposure. Lung function may also be affected by a childâ€™s gender and asthma status.Objective To compare peak expiratory flow (PEF) in pediatric passive smokers to that of children not exposed to second hand smoke, and to define factors that may affect PEF in passive smokers.Methods In August 2009 we conducted a cross-sectional study at an elementary school in the Langkat district. Subjects were aged 6 to 12 years, and divided into two groups: passive smokers and those not exposed to secondhand smoke. Subjectsâ€™ PEFs were measured with a Mini-Wright peak flow meter. Measurements were performed in triplicate with the highest value recorded as the PEF. Demographic data including age, sex, weight, height, family income, parental education levels and occupations were obtained through questionnaires.Results Of the 170 participants, 100 were passive smokers and 70 were not exposed to secondhand smoke. Age distribution, weight and height were similar in both groups. We observed a significant difference in PEFs between the group of passive smokers and the group not exposed to secondhand smoke, 211.3 L/minute (SD 61.08) and 242.7 L/minute (SD 77.09), respectively (P < 0.005). The number of years of exposure to smoke (P = 0.079) and the number of cigarettes smoked daily in the household (P = 0.098) did not significantly influence PEF.Conclusion The PEF in pediatric passive smokers was significantly lower than that of children not exposed to secondhand smoke. PEF in passive smokers was not influenced by the number of years of smoke exposure or the number of cigarettes smoked daily in the household.

Food and migraine in adolescents Magda Bouhairet; Muhammad Ali; Bistok Saing; Johannes Harlan Saing; Yazid Dimyati
Paediatrica Indonesiana Vol 51 No 4 (2011): July 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.4.2011.223-6

Background Migraine headaches are a common problem worldwide, especially in adolescents. They are usually chronic, with frequent relapses. Therefore, any dietary risk factor for headaches has important implications on migraineurs. However, the association between migraine and diet needs to be examined further.Objective To investigate the association between diet and migraine in adolescents.Methods We conducted a cross-sectional study in August to September 2009 on 13 - 18 year old adolescents in a senior high school in Medan, North Sumatera. We included subjects diagnosed with migraine, according to the International Headache Society (IHS) criteria. Ninety participants completed the questionnaire. Foods we observed for a link to migraine included milk, chocolate, ice cream, cheese, bread, instant noodles, meatballs, chili sauce, sweetener, yoghurt, pizza, and other foods and beverages.Results Of the 90 participants with migraines, there were more females (61.1%) than males. There were statistically significant associations between migraine and triggering foods (P = 0.045, 95% CI 0.59 to 0.79) as well as between migraine and family history of migraine (P = 0.043, 95% CI 0.46 to 0.66). Stress (P = 0.164), menstruation (P = 0.369), and sound or light (P= 0.577) had no significant association with migraine. A wide variety of foods and beverages were implicated as migraine precipitants. The most common were chili sauce (75.8%), ice cream (71.0%), milk (67.7%), instant noodles (67.7%), chocolate (61.3%), peanuts (59.7%), cheese (54.8%) and meatballs (54.8%).Conclusion Food and family history have a significant association with the occurrence of migraine in adolescents.Â

Consanguinity and congenital heart disease in offspring Aris Fazeriandy; Muhammad Ali; Johannes H. Saing; Tina Christina L. Tobing; Rizky Adriansyah
Paediatrica Indonesiana Vol 58 No 2 (2018): March 2018
Publisher : Indonesian Pediatric Society

Background Congenital heart disease (CHD) is a common congenital abnormality in children. Consanguineous marriage has been identified as a risk factor of CHD. There was an autosomal recessive pattern of inheritance seen in children with some forms of congenital heart disease. Objective To assess the possible association between consanguineous marriage and congenital heart disease incidence in the offspring. Methods A case-control study was conducted from March to May 2016 on pediatric patients at H. Adam Malik General Hospital, Medan. Subjects were allocated into two groups, 100 children with CHD in the case group, and the rest in the control group. Data were analyzed using Chi-square and logistic regression tests. In the present study, P value less than 0.05 was considered statistically significant. Results In the case group, 14 patients (14%) were born of consanguineous marriages. In the control group, only 5 patients (5%) were born of consanguineous marriages. There was a significant association between consanguineous marriage and CHD (OR 1.551; 95%CI 1.138 to 2.113). Based on the result of multivariate analysis, consanguineous marriage was a risk factor for CHD in offspring (Wald=4.525; P=0.033). Conclusion Consanguineous marriage is a risk factor for CHD in offspring.

Quality of life in children with congenital heart disease after cardiac surgery Sindy Atmadja; Tina Christina Tobing; Rita Evalina; Sri Sofyani; Muhammad Ali
Paediatrica Indonesiana Vol 57 No 6 (2017): November 2017
Publisher : Indonesian Pediatric Society

Background Major achievements in congenital heart disease (CHD) treatment over the past 20 years have altered the course and prognosis of CHD. Improvement of quality of life (QoL) is now a major goal of CHD treatment. Objective To assess the QoL in children after cardiac surgery for CHD. Methods A cross-sectional study was performed in children aged 2 to 18 years. The case group had 20 children with a history of corrective heart surgery in the 12 months prior to the study. The control group had 20 healthy children, age-matchedÂ to the case group. The QoL of both groups was assessed by Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales. The same post-operative children were also assessed with the PedsQL Cardiac Module. Data were analyzed using T-test with P < 0.05 as the level of significance. Results This study recruited 40 subjects: 20 post-operative and 20 healthy children. PedsQL Generic Core Scales assessment showed significant differences between groups in the physical function parameter of QoL (P<0.05) in children aged 13-18 years, but there were no significant differences in the social, emotional, and school function parameters. In children aged 2-12 years, there were no significant differences in physical, social, emotional, or school parameters. The PedsQL Cardiac Module assessment revealed that 35% of post-operative children was at risk for physical appearance problems, 80% was at risk for anxiety problems, 40% was at risk for cognitive problems, and 80% was at risk for communication problems. Conclusion Thirteen to 18-year-old children with non complex CHD have poorer physical function than healthy children. Post operative children are at risk for physical appearance, anxiety, cognitive, and communication problems.

Association between oxygen saturation and critical congenital heart disease in newborns Lidia Halim; Muhammad Ali; Tiangsa Sembiring
Paediatrica Indonesiana Vol 58 No 2 (2018): March 2018
Publisher : Indonesian Pediatric Society

Background Critical congenital heart disease (CCHD) is relatively common, with a prevalence of 6-8 in every 1,000 live births. This congenital anomaly is a newborn condition that would be ideally suited for a screening program, if simple and reliable methods were available. Pulse oximetry (PO) has been proposed as a screening method to detect CCHD. Objective To assess for a possible association between decreased oxygen saturation and CCHD in newborns. Methods We conducted a cross-sectional study from March 2014 to February 2015 in several hospitals in North Sumatra. Healthy, full term and post-term newborns aged 2 to 72 hours underwent pulse oximetry measurements on the right hand and one of the lower extremities. If oxygen saturation (SpO2) was â‰¤ 95%, the measurement was repeated 2 more times. Subjects also underwent echocardiography. Results A total of 386 newborns underwent SpO2 measurements: 377 newborns had SpO2 > 95% and 9 newborns had SpO2 â‰¤ 95%. Of the infants with SpO2 > 95%, 297 were excluded because their parents refused echocardiography examination. Thus, 80 newborns with SpO2 > 95% and 9 newborns with SpO2 â‰¤ 95% underwent echocardiography. Echocardiography revealed that 5 of 9 newborns with SpO2 â‰¤ 95% suffered from Tetralogy of Fallot (ToF) (3 subjects) and transposition of the great arteries (TGA) (2 subjects). One infant with SpO2 > 95% had ventricular septal defect (VSD), as detected by echocardiography. Oxygen saturation â‰¤ 95% had significant association with CCHD (P<0.001). Conclusion Decreased oxygen saturation has a significant association with critical congenital heart disease in newborns.

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