Blood count to determine chronic inflammation severity in obese adolescents

Background Obesity is a growing public health problem of rapidly increasing prevalence in developing countries. Chronic low-grade inflammation plays a key role in the pathophysiology of obesity. Blood count values and ratios have been used as markers of inflammatory diseases. These parameters may be useful to determine the severity of chronic inflammation in obese children. Objective To determine if red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-to-lymphocyte ratio (PLR) can be useful for determining the severity of chronic inflammation in obese children. Methods This observational, analytic study was conducted in obese adolescents aged 14-18 years at senior high schools in Manado, North Sulawesi, from July to September 2018. Students with congenital anomalies, autoimmune diseases, history of asthma, or malignancy were excluded. Pearson’s correlation was used to analyze for potential relationships between obesity and red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-to-lymphocyte ratio (PLR). Results There was a negative relationship between obesity and MPV, but it was not statistically significant (r=-0.006; P=0.485). There were positive, but not significant relationships between obesity and RDW (r=0.139; P=0.192), NLR (r=0.155; P=0.166), PDW (r=0.02; P=0.45), and PLR (r=0.146; P=0.181). Conclusion The RDW, NLR, MPV, PDW, and PLR values are not significantly associated with severity of obesity in adolescents.  

Hubungan Dosis Kumulatif Doksorubisin Terhadap Fungsi Sistolik Ventrikel Kiri pada Penyintas Leukemia Limfoblastik Akut

Latar belakang. Seiring meningkatnya angka harapan hidup anak dengan leukemia limfoblastik akut (LLA), kardiotoksisitas akibat kemoterapi seperti antrasiklin menjadi semakin penting. Evaluasi berkala fungsi sistolik ventrikel kiri melalui fraksi ejeksi (FE) dan fraksi pemendekan (FP) direkomendasikan untuk pemantauan efek samping kardiotoksisitas antrasiklin.Tujuan. Penelitian ini bertujuan untuk melihat hubungan antara dosis kumulatif doksorubisin dengan fungsi sistolik ventrikel kiri pada penyintas LLA anak. Metode. Penelitian ini menggunakan metode kohort retrospektif dengan menilai perubahan FE dan FP menggunakan ekokardiografi pada penyintas LLA pada bulan Juli-September 2016 di bagian Ilmu Kesehatan Anak, RSU Prof. dr. R. D. Kandou, Manado. Pengambilan sampel dilakukan dengan cara total sampling. Analisis statistik dilakukan dengan menggunakan korelasi Pearson.Hasil. Terdapat total 18 penyintas LLA yang diteliti, termasuk 12 risiko standar dan 6 risiko tinggi. Fungsi sistolik ventrikel kiri semua penyintas masih dalam batas normal (FE 74,20 ± 11,37 %, FP 42,61 ± 9,98 %). Ditemukan adanya hubungan negatif sedang yang bermakna antara dosis kumulatif doksorubisin dan fungsi sistolik ventrikel kiri [FE (r=-0,532, p=0,012) dan FP (r=-0,518, p=0,014)]. Kesimpulan. Terdapat hubungan negatif antara dosis kumulatif doksorubisin dan fungsi sistolik ventrikel kiri pada penyintas LLA anak. Panduan lokal diperlukan untuk evaluasi ekokardiografi secara berkala pada penyintas LLA anak di Indonesia. 

Thrombospondin-1 and blood pressure in 7-8-year-old children born low birth weight and small for gestational age

Background Thrombospondin-1 (TSP-1) is associated with endothelial damage, glomerular impairment, and hypertension. Low birth weight (LBW) and small for gestational age (SGA) children have higher risk of morbidity and mortality.Objective To assess for a possible association between TSP-1 level and blood pressure in children who were born low birth weight and small for gestational age.Methods We conducted a cross-sectional study from March to May 2015. Inclusion criteria were children who were born LBW and SGA in 2007-2008 at Prof. Dr. R. D. Kandou General Hospital, resided in Manado, North Sulawesi, had complete medical records, and whose parents consented to their participation. Exclusion criteria were children who were in puberty, obese, had renal disease, taking medications that affect blood pressure, or who were admitted to the hospital in the 2 weeks prior to enrollment.  Data were analyzed using regression and simple correlation tests to assess for associations between TSP-1 and birth weight, as well as TSP-1 and blood pressure.Results Subjects’ mean TSP-1 level was 257.95 ng/dL. There was a strong negative correlation between TSP-1 and birth weight (r=-0.784; P<0.0001). In addition, there were strong positive correlations between TSP-1 level and systolic blood pressure (r=0.718; P<0.0001) as well as TSP-1 and diastolic blood pressure (r=0.670; P<0.0001).Conclusion Higher TSP-1 is associated with higher systolic and diastolic blood pressure in 7-8-year-old children who were LBW and SGA at birth. Also, TSP-1 and birth weight have a strong negative correlation.

Plasmodium falciparum found in the bone marrow of a child in Manado City, East Indonesia: A case report

In Indonesia, there are at least 1.3 million cases of malaria each year and Plasmodium falciparum appears to be the most common Plasmodium. The finding of Plasmodium is important for the diagnosis and management of malaria. This is a case of a 4-year-and-9-month-old male who lived in Manado, East Indonesia. He presented with a prolonged fever, was pale in appearance, and was easily fatigued over the last 3 weeks. Hepato-splenomegaly was found on the initial physical examination. Preliminary laboratory findings found pancytopenia and severe anemia. Before he was referred to our hospital, at the primary health center, the initial work-up was negative for Plasmodium with the serial Rapid Diagnostic Test and microscopic peripheral blood smears. Since there were signs and symptoms mimicking malignancy, the patient was referred to our hospital for further malignancy work-up. A bone marrow puncture was done and we incidentally found Plasmodium falciparum in a microscopic bone marrow smear. This was a rare case because Plasmodium was not initially found in the preliminary work-up (Rapid Diagnostic Test and Microscopic) and qPCR is not a routine work-up for Plasmodium suspected patients. Although the mortality rate of malaria is high, this condition can be treated if the clinician was aware of the clinical signs and symptoms in the early onset and prompt medical treatment is administered. In a severe case with an unclear etiology of fever and with signs and symptoms mimicking malignancy, qPCR is recommended. However, a bone marrow puncture can also be considered to exclude the possibility of a malaria infection.

Parental Experiences with Chemotherapy-Induced Alopecia among Childhood Cancer Patients in Indonesia

BACKGROUND

This study assessed parental experiences with chemotherapy-induced alopecia among children with cancer treated at an Indonesian academic hospital.

MATERIALS AND METHODS

Fifty parents of childhood cancer patients were interviewed using semi-structured questionnaires.

RESULTS

The moment that hair fell out was the moment that parents (84%) had to admit their child had cancer. Alopecia was a traumatizing painful experience (46%). Active strategies to hide alopecia, mainly hats, were used by 66% of children, while 34% never covered their bald head. If money had not been an issue, 40% would use another strategy. Alopecia made children limit outdoor daily activities (78%) and engagement with others (60%). Significantly more children from high-educated (95%) than low-educated (60%) parents received sympathy from other people (P=0.012). Significantly more Christian (29%) than Muslim (0%) families confirmed that alopecia lowered the quality of life (P=0.046). Most parents (82%) had no prior plans about alopecia management, yet for significantly more girls (26%) than boys (0%) such plans existed (P=0.044). Parents received most information about alopecia from other parents (66%). Parents (92%) needed more alopecia education from doctors. Of all school-attending children, 53% were bullied and 47% did not want to attend school due to alopecia. Significantly more high-educated than low-educated families received pity from teachers and pupils (94% vs. 0%, P=0.004), and acceptance by pupils (81% vs. 0%, P=0.021).

CONCLUSIONS

Alopecia is a severe, far-stretching side-effect of chemotherapy with physical, psychological and social consequences for children and parents. Parents should be better informed about occurrence and impact of alopecia. Extra attention is required to facilitate children's return to school. Health- care providers should facilitate optimal supportive care through open dialogue and provision of educational materials for parents, children and their community.

Hubungan antara Anemia dengan Perkembangan Neurologi Anak Usia 12-24 bulan

Latar belakang. Kejadian anemia selama periode kritis perkembangan otak anak dapatmengakibatkan keterlambatan pertumbuhan dan perkembangan anak secara umum.Tujuan. Untuk mengetahui hubungan antara anemia dengan perkembangan neurologipada anak usia 12-24 bulan.Metoda. Penelitian analitik dengan desain potong lintang dilakukan di PosyanduPuskesmas Kecamatan Wawonasa mulai bulan September-Oktober 2004. Subjekpenelitian adalah anak berusia 12-24 bulan yang memenuhi kriteria inklusi. Penentuananemia sesuai kriteria WHO (kadar hemoglobin usia 6 bulan – 5 tahun < 11 g/dl).Perkembangan anak dinilai menggunakan Bayley Infant Neurodevelopmental Screener(BINS). Hasil pemeriksaan dinyatakan dalam 3 kategori yaitu risiko rendah, risiko sedangdan risiko tinggi. Data dianalisis dengan korelasi Spearman rank.Hasil. Subjek penelitian 49 anak terdiri dari 31 (63,3%) laki-laki dan 18 (36,7%)perempuan; didapat proporsi anak anemia 16 (32,7%). Pada kelompok anemiadidapatkan 7 (43,8%) anak kategori risiko tinggi dan 7 (43,8%) risiko sedang. Terdapathubungan yang lemah antara kadar hemoglobin dengan perkembangan neurologi anakusia 12-24 bulan (rs = 0,429;p = 0,001).Kesimpulan. Anak usia 12-24 bulan dengan anemia mempunyai risiko tinggi terhambatdalam perkembangan neurologi.

Platelet Distribution Width dan Mean Platelet Volume: Hubungan dengan Derajat Penyakit Demam Berdarah Dengue

Latar belakang. Diperlukan petanda klinis praktis yang dapat digunakan untuk memprediksi progresivitas demam berdarah dengue (DBD) dan sindrom syok dengue (SSD).Tujuan. Mencari hubungan antara platelet distribution width (PDW) dan mean platelet volume (MPV) dengan derajat penyakit infeksi dengue.Metode. Penelitian dilakukan dengan desain potong lintang. Didiagnosis DBD atau SSD berdasarkan kriteria WHO 1997. Data berupa hematokrit, jumlah trombosit, PDW, dan MPV dikumpulkan selama penelitian. Analisis statistik menggunakan t-test dan regresi linear.Hasil. Didapatkan delapan puluh sembilan anak yang mengikuti penelitian, 71 (79,8%) didiagnosis DBD dan 18 (20,2%) SSD. Korelasi negatif didapatkan antara PDW dan jumlah trombosit (r=-0,77; p<0,05); serta antara MPV dan jumlah trombosit (r=-0,52; p< 0,05). Rerata nilai PDW berbeda secara bermakna pada kelompok trombositopenia dan non trombositopenia (10,46 vs 8,07%; p<0,05) begitu juga nilai MPV (10,12 vs 8,84fl; p<0,05). PDW didapatkan lebih tinggi pada SSD dibanding dengan DBD (11,64 vs. 9,72%; p<0,05) begitu MPV (10,38 vs 8,53 fl; p<0,05). Didapatkan korelasi positif antara hemokonsentrasi dan PDW (r=0,217; p<0,05) begitu juga antara hemokonsentrasi dan MPV (r=0,118; p<0,05).Kesimpulan. PDW dan MPV dapat digunakan sebagai prediktor progresivitas dari DBD.

Jumlah Trombosit dan Mean Platelet Volume Sebagai Faktor Prognosis pada Sepsis Neonatorum

Latar belakang. Sepsis neonatorum merupakan penyebab utama morbiditas dan mortalitas pada neonatusdi negara berkembang. Penelitian terdahulu menunjukkan penurunan jumlah trombosit dan peningkatanmean platelet volume (MPV) berhubungan dengan infeksi invasif atau infeksi yang tidak responsif denganpemberian antibiotik.Tujuan. Untuk mengetahui apakah jumlah trombosit dan MPV berhubungan dengan mortalitas pada sepsisdan meneliti faktor klinis lain yang berhubungan dengan mortalitas pada sepsis neonatorum.Metode. Penelitian analisis retrospektif dari catatan medis sejak bulan Januari – Agustus 2009 di bangsalneonatus RSU Prof.Dr.R.D.Kandou, Manado. Subjek penelitian mencakup neonatus dengan sepsis yangdibuktikan melalui hasil biakan darah dan bayi dengan kelainan kongenital mayor dieksklusi. Variabel yangditeliti antara lain jumlah trombosit, MPV, berat badan lahir, usia gestasi, dan usia saat masuk rumah sakit.Analisis statistik dengan menggunakan metode analisis univariat dan analisis logistik regresi.Hasil. Terdapat 36 neonatus dengan sepsis neonatorum, di antara mereka 22 neonatus (61%) sembuh dan14 (39%) meninggal. Hubungan jumlah trombosit dan mean platelet volume tidak bermakna secara statistikdengan mortalitas (berturut-turut, p=0,589 and p=0,59) , demikian pula halnya dengan berat lahir, usiagestasi, dan usia saat masuk rumah sakit.Kesimpulan. Tidak ada hubungan antara penurunan jumlah trombosit dan peningkatan MPV denganmortalitas pada sepsis neonatorum.

Faktor Risiko Sepsis Awitan Dini

Latar belakang. Insiden sepsis neonatorum masih tinggi, oleh karena itu diperlukan perhatian khusus padadeteksi dini untuk tata laksana lebih dini.Tujuan. Mengetahui faktor risiko potensial yang menyebabkan sepsis awitan dini.Metode. Studi retrospektif kohort dilaksanakan pada Bagian Neonatologi RS Prof DR RD Kandou daribulan Januari - Juli 2009. Kriteria inklusi adalah bayi yang dilahirkan di RS Prof. R.D. Kandou yang memilikifaktor risiko sepsis. Faktor risiko sepsis apabila terdapat dua faktor risiko mayor atau satu faktor risikomayor dengan dua faktor risiko minor. Diagnosis sepsis ditegakkan berdasarkan adanya gejala klinis danfaktor risiko sepsis serta pemeriksaan laboratorium. Data dievaluasi dengan Pearson chi-square dan Fisher’sexact test, dianalisis dengan SPSS 17. Dikatakan berhubungan signifikan antara faktor risiko dengan sepsisbila p<0,05.Hasil. Dari 72 kasus bayi dengan faktor risiko sepsis, 58 bayi didiagnosis sepsis. Hanya ketuban pecah dini>18 jam yang merupakan salah satu faktor risiko mayor berhubungan signifikan dengan sepsis (p=0,002,IK95% 1,2 4;1,59). Faktor risiko mayor lain yaitu demam intrapartum >38oC, korioamnionitis, ketubanberbau, denyut jantung janin >160x/menit dan faktor risiko minor yang meliputi ketuban pecah dini >12jam, demam intrapartum >37,50C, skor APGAR rendah, bayi berat lahir sangat rendah, kembar, usia kehamilan<37 minggu, keputihan, infeksi saluran kemih tidak berhubungan dengan sepsis.Kesimpulan. Ketuban pecah dini >18 jam berhubungan dengan sepsis awitan dini.

Hubungan Ketebalan Intima Media Arteri Karotis dan Massa Ventrikel Kiri pada Remaja Obes

Latar belakang. Obesitas pada anak berhubungan dengan peningkatan risiko kematian yang disebabkan aterosklerosis dan kardiomiopati pada saat dewasa. Ketebalan intima media (KIM) arteri karotis dan massa ventrikel kiri (MVK) adalah penanda awal aterosklerosis dan kardiomiopati yang dapat diperiksa sejak usia dini.Tujuan.Mengetahui hubungan antara KIM arteri karotis dan MVK pada remaja obes. Metode.Penelitian observasional analitik dengan pendekatan potong lintang terhadap 45 remaja usia 13-18 tahun dari bulan November 2013 – Februari 2014. Subyek dibagi menjadi obes dan tidak obes berdasarkan IMT menurut umur dan jenis kelamin. Penilaian KIM dan MVK dengan ekokardiografi. Pengolahan data dengan uji Mann-Whitney, uji t tidak berpasangan. Hubungan antara KIM dengan MVK ditentukan dengan uji regresi linier.Hasil.Terdapat perbedaan bermakna antara KIM remaja obes (rerata 0,79 mm, SB 0,77) dibandingkan tidak obes (rerata 0,23 mm, SB 0,22) (p<0,001). Rerata MVK remaja obes 456,75 g (SB 204,39) berbeda bermakna dengan rerata MVK tidak obes 138,24 g (SB 24,19) (p<0,001). Terdapat hubungan antara KIM dengan MVK pada remaja obes (r=0,374 p=0,006).Kesimpulan. Ketebalan intima media arteri karotis dan MVK pada remaja obes berbeda bermakna dibandingkan tidak obes. Pada remaja obes terjadi peningkatan KIM dan MVK. Terdapat hubungan peningkatan KIM arteri karotis dengan peningkatan MVK pada remaja obes.

Birth weight and blood pressure in first-grade elementary school students: A preliminary study

Background Fetal programming theory reveals that low birthweight is associated with higher risks of hypertension and cardio-vascular diseases in the adulthood.Objective To study the difference in blood pressure among first-grade students of different birth weight groups.Methods A cross-sectional study was performed. Blood pressureof 214 healthy first-grade elementary school students (102 malesand 112 females) in Bunaken Subdistrict, Manado, Indonesia, wasmeasured using a standard sphygmomanometer with appropriatecuff for arm size. Two readings were taken. Parents were asked tocomplete a questionnaire concerning the information on birth weightand length and confirmed by retrieving the record on a growthchart and/or a maternal-child health book. The subjects were di-vided into 6 groups according to their birth weight. The differencesin blood pressure values between birth weight groups were exam-ined by ANOVA.Results Systolic blood pressures were significantly higher in the<2500 g birth weight group (100.73+9.99 mmHg vs. 93.70+8.29mmHg) and in the 2500-<3000 g birth weight group compared tothose of the 3500-<4000 g one (99.56+9.14 mmHg vs. 93.70+8.29mmHg) with a P of 0.048 and 0.014, respectively. There was nodifference between diastolic blood pressure and birth weight.Conclusion Our study showed that the lower birth weight grouptends to have a higher systolic blood pressure than that of childrenwith normal birth weight

The association between nutritional status and motor development in children under five years old

Background Severe malnutrition in children is closely related todelayed physical growth and mental development. Very few re-ports mention the effects of mild to moderate malnutrition on mo-tor development.Objective The objective of this study was to determine the rela-tionship between nutritional status and motor development in earlychildhood.Methods In this cross-sectional study, we examined body weightof children under 5 years of age, the ability to sit or walk withoutsupport, and parachute sign in those under 2 years of age whocame to community child health surveillance posts in TumintingSubdistrict, Manado, Indonesia.Results Among 359 under-five children, 296 were well-nourishedand 63 had mild to moderate malnutrition. The ability to sit withoutsupport in malnourished children was significantly delayed com-pared to that in well-nourished ones (P=0.03). The ability to walkwithout support and parachute sign were not significantly differentbetween the two groups.Conclusion The ability to sit without support in children with mildto moderate malnutrition is delayed compared to that in well-nour-ished ones

Comparing Health-Care Providers' Perspectives on Complementary and Alternative Medicine in Childhood Cancer Between Netherlands and Indonesia

BACKGROUND

Use of complementary and alternative medicine (CAM) is common among patients with childhood cancer. Health-care providers (HCP) should address this need properly. Geographical and cultural differences seem likely. This study explores perspectives on CAM of HCP involved in the care of children with cancer in Netherlands and Indonesia. Health beliefs, components of CAM, encouraging or discouraging CAM, and knowledge about CAM were assessed.

PROCEDURE

We conducted a cross-sectional study using semi-structured questionnaires at a Dutch and Indonesian academic hospital.

RESULTS

A total of 342 HCP participated: 119 Dutch (response rate 80%) and 223 Indonesian (response rate 87%). Chemotherapy can cure cancer according to more Dutch than Indonesian HCP (87% vs. 53% respectively, P < 0.001). Combination of chemotherapy and CAM is the best way to cure cancer according to more Indonesian than Dutch HCP (45% vs. 25%, P < 0.001). Dutch and Indonesian HCP recommend and discourage CAM use differently. Most Dutch (77%) and Indonesian HCP (84%) consider their knowledge about CAM to be inadequate (P = ns). Fewer Dutch doctors than other HCP want to learn more about CAM (51% vs. 76%, P = 0.007), whereas there is no significant difference in eagerness to learn about CAM between Indonesian doctors (64%) and other HCP (72%).

CONCLUSIONS

Indonesian HCP have more positive views about CAM than their Dutch colleagues. Both Dutch and Indonesian HCP consider their knowledge about CAM to be inadequate. Therefore, education programs about CAM tailored to the needs of HCP are recommended, knowing that CAM is used frequently.

Lead poisoning and cystatin-C in children

Background Lead pollution is a global problem both in developed and developing countries. Lead poisoning is associated with decreased glomerular filtration rate (GFR) and is a risk factor for acute kidney injury (AKI). Serum cystatin-C is a more precise test of GFR than serum creatinine level, as serum cystatin-C levels rise earlier than serum creatinine, when GFR decreases. Objective To assess for a possible correlation between lead poisoning and cystatin-C levels in children. Methods We conducted a cross-sectional study in children aged 6-11 years with a history of lead poisoning from elementary schools in Talawaan District, North Minahasa Regency from July to October 2013. Cystatin-C and blood lead levels (BLL) were measured in all subjects. Spearman’s rho test was used to analyze a potential correlation between BLL and cystatin-C level. Results This study included 41 children, comprising 21 boys and 20 girls. Their median age was 8.50 (range 6.8-10.7) years. Elevated levels of cystatin-C did not exceed normal values, however, we found a positive correlation between BLL and cystatin C (r=0.419, P=0.006). Conclusion There is a positive correlation between BLL and cystatin C level in children with lead poisoning. Regular monitoring of BLL, medical intervention, and an epidemiological study to help find the sources of contamination are needed for children with lead poisoning.

Parents' and health-care providers' perspectives on side- effects of childhood cancer treatment in Indonesia

BACKGROUND

Efficacy of childhood cancer treatment in low-income countries may be impacted by parents' and health-care providers' perspectives on chemotherapy-related side-effects. This study explores prevalence and severity of side-effects in childhood cancer, and compares health beliefs about side-effects between parents and health-care providers, and between nurses and doctors in Indonesia.

MATERIALS AND METHODS

Semi-structured questionnaires were filled in by 40 parents and 207 health-care providers in an academic hospital.

RESULTS

Parents exporessed a desire to receive more information about side-effects (98%) and worried about this aspect of treatment (90%), although side-effects were less severe than expected (66%). The most frequent was behavior alteration (98%) and the most severe was hair loss. Only 26% of parents consulted doctors about side-effects. More parents, compared to health-care providers, believed that medicines work better when side-effects are more severe (p<0.001), and accepted severe side-effects (p=0.021). More health-care providers, compared to parents, believed that chemotherapy can be stopped or the dosage altered when there are side-effects (p=0.011). More nurses, compared to doctors, stated that side-effects were unbearable (p=0.004) and made them doubt efficacy of treatment (p<0.001).

CONCLUSIONS

Behavior alteration is the most frequent and hair loss the most severe side-effect. Apparent discrepancies in health beliefs about side-effects exist between parents and health-care providers. A sustainable parental education program about side-effects is recommended. Health-care providers need to update and improve their knowledge and communication skills in order to give appropriate information. Such measures may improve outcome of childhood cancer treatment in low-income countries, where adherence to therapy is a major issue.

Socio-economic status plays important roles in childhood cancer treatment outcome in Indonesia

BACKGROUND

The influence of parental socio-economic status on childhood cancer treatment outcome in low-income countries has not been sufficiently investigated. Our study examined this influence and explored parental experiences during cancer treatment of their children in an Indonesian academic hospital.

MATERIALS AND METHODS

Medical charts of 145 children diagnosed with cancer between 1999 and 2009 were reviewed retrospectively. From October 2011 until January 2012, 40 caretakers were interviewed using semi-structured questionnaires.

RESULTS

Of all patients, 48% abandoned treatment, 34% experienced death, 9% had progressive/ relapsed disease, and 9% overall event-free survival. Prosperous patients had better treatment outcome than poor patients (P<0.0001). Odds-ratio for treatment abandonment was 3.3 (95%CI: 1.4-8.1, p=0.006) for poor versus prosperous patients. Parents often believed that their child's health was beyond doctor control and determined by luck, fate or God (55%). Causes of cancer were thought to be destiny (35%) or God's punishment (23%). Alternative treatment could (18%) or might (50%) cure cancer. Most parents (95%) would like more information about cancer and treatment. More contact with doctors was desired (98%). Income decreased during treatment (55%). Parents lost employment (48% fathers, 10% mothers), most of whom stated this loss was caused by their child's cancer (84% fathers, 100% mothers). Loss of income led to financial difficulties (63%) and debts (55%).

CONCLUSIONS

Treatment abandonment was most important reason for treatment failure. Treatment outcome was determined by parental socio-economic status. Childhood cancer survival could improve if financial constraints and provision of information and guidance are better addressed.

Treatment of ulcerated hemangiomas with propranolol: an evidence-based case report

Hemangiomas are the most frequent vasculartumors observed in early childhood. Thepresentation is unique, with an initialphase of proliferation, followed by aphase of slow, spontaneous regression after the age of1 year.1,2 Most hemangiomas are uncomplicated anddo not require intervention. However, therapy may beneeded if the hemangioma is located at certain bodysites, such as the face, or if it results in a functionalhandicap, such as limitation of eye opening. Inaddition, ulcerated, rapidly growing hemangiomasmay require treatment.3

Immunophenotypic patterns of childhood acute leukemias in Indonesia

BACKGROUND

Immunophenotyping, as suggested by WHO, may improve diagnosis of childhood leukemia since it offers a better classification of the hematopoietic lineage of malignant cells as compared to morphology. Therefore, we aimed to determine the proportion of the immunophenotypic subtypes of acute leukemia in Indonesian children.

METHODS

Samples were obtained from patients (0-14 years of age) in 4 hospitals in Indonesia. We analyzed 541 suspected leukemia samples presented over a 4-year period (March 2006 - July 2010) by flow cytometry. Immunophenotyping allowed classification into acute myeloid leukemia (AML) and ALL (B-lineage and T-lineage ALL).

RESULTS

Of 541 samples, 136 were tested using a single color method and 405 with a three-color method. Concordance with morphology was very good (?=0.82) using the three-color method with a panel of 15 monoclonal antibodies (n=387). A relatively high percentage of acute leukemia was classified as AML (23%). Of the ALL samples 83% were B-lineage ALL and 17% T- lineage ALL. Nine out of 239 morphological ALL were labeled AML, and 12/79 morphological AML were in fact ALL.

CONCLUSION

Immunophenotyping in a multi-center study proved feasible and appears particularly important for prognostic assessment of childhood leukemia in low income countries such as Indonesia.

Varicella outbreak in a pediatric oncology ward: the Manado experience

BACKGROUND

Varicella is highly contagious and dangerous disease, especially in immunocompromised patients. Children with cancer are at increased risk of severe illness and fatal cases occur.

OBJECTIVE

To describe an outbreak of varicella among in-patient cancer children, family members and staff. Estella Children Cancer Center in Manado, Indonesia with 14 beds and a 15 bed capacity guest house for family members.

METHODS

A retrospective study of patients, family members and staff who were diagnosed with varicella based on clinical appearance was performed. Follow up was until 28 days from the last patient diagnosis' date.

RESULTS

From late February to early May 2009, varicella was affecting 4 among 8 children with leukemia, 1 family member and 1 housekeeping staff. Measurers taken after the index case were oral acyclovir both for patients and contacts, patient isolation, ward disinfection and some chemotherapy interruption. Nevertheless, a second and third wave of varicella occurred. The index case died due to encephalitis. Other patients were non-severe and cured, but one child was lost to follow up.

CONCLUSIONS

This outbreak highlights the importance of proper prevention and prompt management of varicella in immunocompromised patients. Simple and locally applicable guidelines are needed.

Febrile neutropenia in childhood leukemia: Manado experience 1997 - 2006

Background Febrile neutropenia (FNP) is a common complicationof therapy among children with cancer. It is one of the causes ofsignificant morbidity and mortality in children and young adultstreated for cancer. With aggressive management of FNP, theoutcome of episodes in children has improved dramatically.Objective To determine factors associated with FNP, to assess how varied the current management, and to evaluate the outcome of FNP in childhood leukemia in Manado over the last 10 years.Methods Data from medical records was collected retrospectivelyfrom January 1997 to December 2006. Variables studied were: age, sex, nutritional status, sosio-economic status, type of leukemia, degree of fever, ANC at fever, phase of chemotherapy, antibiotic used, episodes ofFNP and the outcome of patients.Results Twenty of ninety one patients were studied. The mortality rate was crucial i.e., 11 of20, it was higher in boys than that in girls. Most children have severe to very severe neutropenia and more than half died (7 /13). Seven out of 12 malnourished patients died. Sixteen children are suffered from acute lymphoblastic leukemia (ALL). The outcome of high risk (HR) patients was worse than that of standard risk (SR). FNP occurred along the phase of chemotherapy. None of the factors studied showed significant difference. The choice of antibiotics is varied.Conclusion The outcome of FNP in our institution is grave.There is a need to evaluate application and compliance to thestandard guidelines.

Evaluation of a comprehensive home-based midwifery programme in South Kalimantan, Indonesia

We report the findings of an evaluation of a programme in three districts in South Kalimantan, Indonesia, which consisted of the training, deployment and supervision of a large number of professional midwives in villages, an information, education and communication (IEC) strategy to increase use of village midwives for birth, and a district-based maternal and perinatal audit (MPA). Before the programme, the midwives had limited ability to manage obstetric complications, and 90% of births took place at home. Only 37% were attended by a skilled attendant. By 1998-99, 510 midwives were posted in the districts and skilled attendance at delivery had increased to 59%. Through in-service training, continuous supervision and participation in the audit system midwives also gained confidence and skills in the management of obstetric complications. Despite this, the proportion admitted to hospital for a caesarean section declined from 1.7 to 1.4% and the proportion admitted to hospital with a complication requiring a life-saving intervention declined from 1.1% to 0.7%. The strategy of a midwife in every village has dramatically increased skilled birth attendance, but does not yet provide specialized obstetric care for all women needing it. The high cost of emergency obstetric interventions may well be the most important obstacle to the use of hospital care.

Liquid chromatographic–tandem mass spectrometric determination of amprenavir (agenerase) in serum/plasma of human immunodeficiency virus type-1 infected patients receiving combination antiretroviral therapy

A selective assay method for quantitation of amprenavir (agenerase) in human immunodeficiency virus type-1 infected patient serum or plasma using liquid chromatography-tandem mass spectrometry (LC-MS-MS) is described. Amprenavir and an internal standard (reserpine) are extracted by liquid-liquid extraction and chromatographically separated by a reversed-phase C18-analytical column. The triple quadrupole LC-MS-MS system is operated in the positive-ion mode and multiple reaction monitoring is used for drug quantitation. The method has been validated over the range of 0.05-10.0 microg/ml. The RSDs for the intra-day and inter-day determinations ranged from 5.3 to 6.1% and from 4.7 to 6.2%, respectively. The average assay accuracy at two different concentrations ranged from 96.0 to 103.0% and the extraction recovery of amprenavir was 90.8%. The lower limit of quantitation was 0.05 microg/ml. Using a short microbore column, the analysis was completed in less than 5 min.

Assessment of age-dependent immunity to malaria in transmigrants

Sixty-six Javanese transmigrants moving from Java, an area of very low malaria transmission, to Irian Jaya, an area of high malaria transmission, were monitored to evaluate the effects of exposure to malaria transmission and age on resistance to infection and the induction of humoral immunity. The risk of acquiring Plasmodium falciparum parasitemia was not statistically greater in children (5-15 years of age) than in adults (> 15 years of age) during the first 14 months of exposure. However, during the cross-sectional survey at 14 months of exposure. children did have significantly higher P. falciparum asexual blood-stage parasite densities. Serum antibody titers to R32LR, a peptide containing sequences from the P. falciparum circumsporozoite repeat region, and MSP19, a proteolytic fragment of merozoite surface protein-1 (MSP-1) from P. falciparum, were measured by enzyme-linked immunosorbent assay. Exposure for both six and 14 months produced statistically significant increased antibody titers to both R32LR and MSP-1; no age-dependent difference in antibody titers was observed. In this population, exposure to malaria transmission induced antibodies to antigens associated with immunity to malaria. In addition, we noted an age-dependent difference in the parasitemia density of P. falciparum.

High-performance liquid chromatographic determination of midazolam in rat brain

A high-performance liquid chromatography method for the determination of midazolam in rat brain is described. Midazolam and the internal standard halazepam were extracted with toluene and analyzed isocratically on a reversed-phase column with a mobile phase consisting of methanol, acetonitrile and potassium phosphate buffer. Detection was monitored by ultraviolet absorption at 240 nm. The standard curves were linear over the range of 25-350 ng midazolam per 50 mg brain tissue. The day-to-day coefficient of variation ranged from 1.7 to 6.9%. The limit of quantification was 80 ng/g brain tissue. The method is rapid, simple and reproducible for brain analysis.

Treatment of experimental status epilepticus with the GABA uptake inhibitor, tiagabine

The potential clinical efficacy of tiagabine for control of status epilepticus was evaluated in an experimental model. Tiagabine was administered to cobalt-lesioned rats in which status epilepticus was induced by injection of homocysteine thiolactone. Tiagabine was effective in controlling status epilepticus in this model; the median effective dose for control of generalized tonic-clonic seizures in the model was 8.3 mg/kg. Tiagabine administration produced an abnormal, hypo-reactive behavioral state which was accompanied by an EEG pattern of high-amplitude, frontally dominant, rhythmic, 3-5-Hz spike-wave activity. This EEG and behavioral syndrome could be reproduced by administration of tiagabine to normal, non-epileptic rats. The exact nature of this syndrome remains unclear, but whether it is an epileptic or encephalopathic phenomenon, further study is clearly required before this drug should be considered for use in the treatment of human status epilepticus.

Malaria vaccine study site in Irian Jaya, Indonesia: Plasmodium falciparum incidence measurements and epidemiologic considerations in sample size estimation

Malaria epidemiologic and entomologic studies were performed during both the high transmission and low transmission seasons to characterize the Plasmodium falciparum malaria transmission at a proposed malaria vaccine trial site in Irian Jaya, Indonesia. The study population consisted of two subsets: native Irianese men with lifelong exposure to malaria and transmigrants who arrived from a nonmalarious area 2.5 years before the start of the study. All subjects received a radical cure for malaria and were then monitored weekly by blood film. Both P. falciparum malaria attack rates and incidence densities were calculated; transmigrants had a significantly higher rate (P = 0.003) than the Irianese during the low transmission season study (20-weeks long) but not during the high transmission season study (12-weeks long). Lack of exposure-induced immunity left the transmigrants at a minimum 17-25% greater relative risk of becoming parasitemic compared with the Irianese during the low transmission season study. During the high transmission season study, 50% of the transmigrants were P. falciparum positive by week 6 and 50% of the Irianese by week 9. During the low transmission season, 50% of the transmigrants were positive by week 10 and 43% of the Irianese were positive by week 17. Entomologic studies showed that Anopheles koliensis was the predominant vector (> 98% of anopheline catch). Entomologic inoculation rates for P. falciparum were 0.018 and 0.39 infective bites/person/night for the low and high transmission seasons, respectively. New P. vivax cases represented between 16% and 42% of all initial malaria cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of lorazepam in rat brain using liquid/liquid and solid-phase extraction in combination with high performance liquid chromatography

A method for the determination of lorazepam in rat brain is described using liquid/liquid and solid-phase extraction, followed by high performance liquid chromatography. After addition of chlordiazepoxide as the internal standard, 100 mg brain tissue was homogenized and incubated with alkaline protease. Lorazepam and chlordiazepoxide were extracted three times with toluene. After treatment through a C18-Bond Elut column, lorazepam and chlordiazepoxide were analyzed isocratically on a reversed-phase column with a mobile phase consisting of methanol +0.025 M sodium phosphate buffer (66:34, v/v). The eluted drugs were monitored by their absorption at 240 nm. The sensitivity limit of this method was 10 ng of lorazepam per 100 mg of brain tissue sample. The standard curve was linear over the range of 20 to 200 ng lorazepam. The coefficient of variation for day-to-day precision established by 21 replicate analyses was 4.5 to 13.6%.

Brain amino acid concentration changes during status epilepticus induced by lithium and pilocarpine

Amino acid concentrations were measured in specific structures from the brains of rats decapitated before and during the course of status epilepticus induced by lithium and pilocarpine, with the stages of status defined by the electroencephalographic (EEG) pattern displayed. Early status was marked by discrete seizures on EEG, mid status by continuous spiking, and late status by periodic epileptiform discharges. Aspartate levels were lower than control levels in most regions prior to the onset of status. The decline continued and reached statistical significance in different regions at times from early to late status. Glutamate concentrations were typically higher than control just prior to status onset and then decreased in a manner similar to aspartate, but with less percentage change. gamma-Aminobutyric acid increased during status, with the earliest statistically significant differences observed in mid status. These changes were observed in most forebrain structures studied, but the largest percentage changes in excitatory amino acid concentration were found in substantia nigra, where they fell to less than half of control.

High-performance liquid chromatographic determination of selected amino acids in rat brain by precolumn derivatization with phenylisothiocyanate

We describe here a simple, sensitive, selective and reproducible assay method for quantitative determination of aspartate, glutamate, serine, glutamine, glycine and gamma-aminobutyric acid in rat brain using reversed-phase high-performance liquid chromatography. The method is based upon formation of phenylthiocarbamyl derivatives of the amino acids. Good resolution of the six amino acids and the internal standard norvaline is achieved within 40 min. Other amino acids which have been reported to be present in rat brain do not interfere with the analysis. Standard curves for each of the amino acids exhibited good linearity (r greater than 0.9993) over the range 0.5-20 nmol. The coefficient of variation for the intra-day and inter-day determinations ranged from 0.4% at the highest to 11% at the lowest concentration limit. Storage of whole brains at -0 degrees C for up to 8 weeks did not affect mean concentrations of the six amino acids.

Determination of lorazepam in plasma of patients during status epilepticus by high-performance liquid chromatography

A reversed-phase high-performance liquid chromatography method for the determination of lorazepam in human plasma has been developed. The method was used to analyze plasma samples obtained from patients who were treated with 0.1 mg/kg of intravenous lorazepam during status epilepticus. The detection limit for lorazepam was 5 ng/ml. None of the most commonly used antiepileptic drugs interfere with this lorazepam analysis.

Simultaneous high-performance liquid chromatographic determination of carbamazepine and its principal metabolites in human plasma and urine

A rapid high-performance liquid chromatographic method is described for the simultaneous determination of carbamazepine and the 10,11-epoxide, 10,11-dihydroxy, and 2-hydroxy metabolites of carbamazepine. The chromatographic system involves the use of a 18C-microsorb, reversed-phase column with acetonitrile/water (28:72) as the mobile phase. Detection and quantitation are monitored by ultraviolet absorption at 212 nm. The compounds are extracted from 250 microliters of plasma or from 100 microliters urine with methyl-t-butyl ether and 0.1 M sodium hydroxide; 2-methylcarbamazepine is added as internal standard. If phenytoin and/or phenobarbital are present in plasma or urine samples, it is necessary to use 1.0 M sodium hydroxide. The limits of quantitation for carbamazepine and its metabolites are 10 ng/ml.

Pharmacokinetics of nafimidone in patients with chronic intractable epilepsy

Nafimidone is a new antiepileptic drug which may be effective in partial onset seizures. We studied the pharmacokinetics of nafimidone and its metabolite, nafimidone alcohol, in 12 patients already taking phenytoin and/or carbamazepine. The half-life of nafimidone was 1.34 +/- 0.48 hours after a 100mg single dose and 1.69 +/- 0.91 hours after a 300mg single dose. However, the half-life of nafimidone alcohol increased from 2.84 +/- 0.72 hours after a 100mg single dose to 4.22 +/- 1.09 hours after a 300mg single dose (p less than 0.02). The clearance of nafimidone was 43.56 +/- 22.11 L/h/kg after a 100mg single dose and 35.51 +/- 28.93 L/h/kg after the 300mg single dose. The respective apparent volumes of distribution of nafimidone after single 100 and 300mg doses were 80.78 +/- 46.11 L/kg and 71.01 +/- 36.86 L/kg. After short term (9 to 10 weeks) and long term (127 to 152 weeks) maintenance therapy on nafimidone 600mg per day the half-life of nafimidone alcohol was 2.23 +/- 0.36 hours and 2.16 +/- 0.60 hours, respectively. No nafimidone could be detected in urine but from 4 to 7% of the daily nafimidone dose was recovered as nafimidone alcohol. Thus, it appears that over 90% of the administered dose of nafimidone is metabolised by pathways other than glucuronidation of nafimidone alcohol and urinary excretion.

High-performance liquid chromatographic determination of nafimidone and its major metabolite nafimidone alcohol in human plasma and urine

A rapid, sensitive and selective method for the determination in plasma and urine of nafimidone, a new antiepileptic drug, and its major metabolite, nafimidone alcohol, has been developed which uses a high-performance liquid chromatographic system and a fluorescence detector for nafimidone or ultraviolet detector for nafimidone alcohol. The detection limits for nafimidone and nafimidone alcohol are 5.0 and 12.5 ng/ml, respectively.

Biomedical survey in Irian Jaya (West Irian), Indonesia

A biomedical survey was conducted in several areas of Irian Jaya, Indonesia in July 1972 in association with an investigation of reports of a cholera outbreak. Stool specimens, blood smears and sera were collected and examined for evidence of parasitic as well as other infectious diseases. A total of 114 stools were examined and the most commonly found intestinal parasites were Trichuris trichiura (94%), Ascaris lumbricoides (74%), hookworm (58%), Entamoeba coli (15%), Endolimax nana (8%), Entamoeba histolytica (7), Entamoeba hartmanni (4%), Giardia lamblia (3%) and Chilomastix mesnili (3%). A total of 513 blood smears were examined and Wucheria bancrofti microfilariae were detected in 4% and malaria in 4% (Plasmodium falciparum 3%, Plasmodium vivax 2%). The malaria and filarial positive individuals lived in Beeuw, Waigeo and Arar, Sorong. These parasitic infections were not detected in people from Biak City and Sburia, Biak. Sera were collected from 357 persons and significant antibody titers were found for Entamoeba histolytica (4%) Toxoplasma gondii (7%), Influenza A2 Hong Kong 68 (65%), Influenza B Taiwan 68 (78%), Japanese encephalitis virus (87%) and Dengue 1 virus (79%).

The prevalence of entamoeba histolytica and Toxoplasma gondii antibodies in Central Java, Indonesia

Sera collected from people living along the slopes of Mt. Merapi and Mt. Merbabu (900-1900 m) in Boyolali Regency, Central Java, Indonesia were tested by indirect hemagglutination tests for antibodies to Entamoeba histolytica and Toxoplasma gondii. A total of 695 sera from 439 males and 256 females, 2 to 75 years of age were tested for amoebiasis and 17.6% had positive antibody titers of 1:128 or greater. The prevalence of antibodies was the same for males and females and increased with age. The seropositivity rate for Toxoplasma gondii antibodies among 438 males and 255 females was 2% at titers of 1:256 or greater. The prevalence was higher in females (2.7%) than in males (1.6%), and was highest in the oldest age groups.