Emil Azlin

Mantoux tests of children in household contact with adult acid fast bacilli-positive or -negative pulmonary tuberculosis

Background Tuberculosis (TB) is the leading cause of mortality and morbidity in developing countries. In children, the major source of TB transmission is adults with pulmonary TB who have acid fast bacilli (AFB)-positive sputum. However, tuberculosis infection can also occur in children in household contact with adults who have AFB-negative pulmonary TB. Objective To compare Mantoux test results and induration diameters in children with adult pulmonary TB household contact who were either positive or negative for AFB, and to assess for possible associations between Mantoux test results with age, family income, and house ventilation in both groups. Method s A cross-sectional study was conducted from January to March 2014. Mantoux test was performed in children aged 3 months to 18 years who had household contact with either AFB-positive or -negative adult pulmonary TB patients. Results A total of 106 children were enrolled in the study. All subjects had household contact with adult pulmonary TB patients who were either AFB-positive (54 children) or AFB-negative (52 children). Mean Mantoux test induration diameters were significantly different between groups (10.9 (SD 6.55) mm vs. 6.2 (SD 5.91) mm, respectively; P=0.001). In addition, there was significantly higher risk of positive Mantoux test in children in contact with adult AFB-positive TB patients than in the AFB-negative group (OR 5.66; 95%CI 2.36-13.59; P=0.0001). However, there were no significant differences in positive Mantoux test results in each of the AFB-positive and -negative groups, with regards to age, family income, or house ventilation. Conclusion Mean Mantoux test induration diameter in children who had household contact with AFB-positive adults is significantly larger than that of the AFB-negative group. Positive Mantoux test results in children are associated with AFB-positive adult TB in the household. There is no association between positive Mantoux test results and age, family income, or house ventilation in both groups.

Perbandingan Pemberian Vitamin K Dosis Tunggal Intramuskular pada Bayi Prematur dan Aterm Terhadap Masa Protrombin

Latar belakang. Defisiensi vitamin K atau hypoprothrombinemia pada bayi baru lahir dapat menyebabkan perdarahan karena faktor koagulasi yang bergantung vitamin K tidak adekuat. Bayi prematur kurang memperlihatkan respon optimal dengan pemberian vitamin K disebabkan imaturitas sel hati. Tujuan penelitian. Mengetahui apakah vitamin K dosis tunggal intramuskular sama efektifnya pada bayi prematur dibandingkan dengan bayi aterm terhadap masa protrombin. Metode. Uji klinis bayi baru lahir prematur dan aterm yang dirawat antara bulan Februari – Juli 2006 di Rumah Sakit Pirngadi Medan. Kriteria eksklusi ialah menggunakan antibiotik, bayi dengan hiperbilirubinemia. Pemeriksaan masa protrombin (PT) dilakukan sebelum pemberian vitamin K pada hari pertama dan diulapng pemeriksaan PT pada hari ketiga terhadap bayi prematur dan aterm. Analisis statistik secara uji t independen dan berpasangan, indeks kepercayaan 95%, kemaknaan p<0,05. Hasil. Dari 38 bayi prematur, 20 laki-laki, 18 perempuan dan 38 bayi aterm, 18 laki, 20 perempuan. Nilai PT bayi prematur hari pertama; rata-rata 38,7±18,4 detik, hari ketiga; 22,9±6,6 detik. Pada bayi aterm PT hari pertama; rata-rata 30,0±17,7 detik, pada hari ketiga rata-rata 16.9±7.3 detik. Tidak bermakna nilai PT pada hari pertama, namun terdapat perbedaan bermakna nilai PT pada hari ketiga antara bayi prematur dan aterm. Rata-rata terjadi penurunan nilai PT pada hari ketiga. Kesimpulan. Terdapat perbedaan bermakna nilai PT antara bayi prematur dengan aterm sebelum dan sesudah diberikan vitamin K dosis tunggal intramuskular. Perubahan nilai PT antara hari pertama dengan hari ketiga baik pada bayi aterm maupun prematur setelah diberikan vitamin K

Rasio Bilirubin Albumin pada Neonatus dengan Hiperbilirubinemia

Latar belakang. Bilirubin tidak terikat potensial membahayakan sistem susunan saraf pusat, dan dapat menyebabkan kerusakan neurologis yang berat dan permanen.Rasio total bilirubin dan albumin dianggap parameter mewakili bilirubin yang tidak terikat,dalam menentukan modalitas terapi untuk hiperbilirubinemia. Tujuan. Mengetahui rasio bilirubin albumin pada pasien hiperbilirubinemia. Metode .Penelitian menggunakan studi sekat lintang yang dilakukan di Divisi Neonatologi RS. H. Adam Malik Medan dan RS. Pirngadi Medan mulai Agustus 2009 – Maret 2010. Hasil. Terdapat hubungan yang bermakna antara kadar albumin dan toral serum bilirubin dengan p<0,05. Kesimpulan. Rasio bilirubin-albumin merupakan parameter jumlah bilirubin bebas, dan dapat digunakan sebagai indikator yang lebih baik dalam penentuan terapi, untuk menurunkan kejadian bilirubin-induced neurologic damage.

Breast milk vs. non-nutritive sucking to reduce pain from minor invasive procedures in neonates

Background Neonates undergo many uncomfortable, invasive minor procedures during their first hospital stay. Nonpharmacological interventions may provide valuable alternatives for pain relief in neonates during minor procedures. Objective To compare the analgesic effect of orally administered breast milk vs. non-nutritive sucking (NNS) in neonates who underwent minor invasive procedures. Methods A randomized, open trial was performed at the Haji Adam Malik Hospital from September to December 2009. Subjects were 96 healthy, term infants who received injections of either intramuscular hepatitis B immunization or vitamin K. Subjects were randomly allocated into two groups, those were the breast milk group (n = 48) and the NNS group (n= 48). Breast milk and NNS were given two minutes before the injection. The events were recorded by video recorder. Transcutaneous heart rate, oxygen saturation and crying times were recorded. Two observers used the premature infant pain profile (PIPP) scale to evaluate all subjects. Result.s In the breast milk group, there was significant reduction in meanPIPPscore (P= 0.001) and mean crying time (P= 0.03) compared to the NNS group. There were no significant differences in mean PIPP score and crying times between males and females (P= 0.4 and P=0.5, respectively). However, there was a significantly lower mean PIPP score for vitamin K injection than for hepatitis B immunization (P=0.002), although mean crying times were not significantly different (P= 0.06). We observed significantly less Oz desaturation at 150 seconds postinjection in the breast milk group compared to that of the NNS group. However, there was no significant difference in heart rate between the two groups throughout the observation period. Conclusion Breast milk administered before an invasive minor procedure effectively reduces pain in neonates. Breast milk administered to neonates prior to injection has reduced mean PIPP scores, crying times, and Oz desaturation, compared to neonates who received NNS in the form of pacifiers.