Endy Paryanto Prawirohartono

The impact of prenatal vitamin A and zinc supplementation on birth size and neonatal survival - a double-blind, randomized controlled trial in a rural area of Indonesia.

BACKGROUND Prenatal supplementation with micronutrients may increase birth weight and thus improve infant health and survival in settings where infants and children are at risk of micronutrient deficiencies. OBJECTIVE To assess whether vitamin A and/or zinc supplementation given during pregnancy can improve birth weight, birth length, neonatal morbidity, or infant mortality. METHODS A double-blind, randomized controlled trial supplementing women (n = 2173) in Central Java, Indonesia throughout pregnancy with vitamin A, zinc, combined vitamin A+zinc, or placebo. RESULTS Out of 2173 supplemented pregnant women, 1956 neonates could be evaluated. Overall, zinc supplementation improved birth length compared to placebo or combined vitamin A+zinc (48.8 vs. 48.5 cm, p = 0.04); vitamin A supplementation improved birth length compared to placebo or combined vitamin A+zinc (48.7 vs. 48.2 cm, p = 0.04). These effects remained after adjusting for maternal height, pre-pregnancy weight, and parity. There was no effect of supplementation on birth weight, the proportion of low birth weight, neonatal morbidity, or mortality. CONCLUSIONS Prenatal zinc or vitamin A supplementation demonstrates a small but significant effect on birth length, but supplementation with zinc, vitamin A or a combination of zinc and vitamin A, have no effect on birth weight, neonatal morbidity, or mortality.

The impact of prenatal vitamin A and zinc supplementation on growth of children up to 2 years of age in rural Java, Indonesia.

OBJECTIVE To determine whether prenatal vitamin A and/or Zn supplementation affects postnatal growth. DESIGN Follow-up of a randomized controlled trial monitoring growth in children from birth up to 24 months of age. SETTING Central Java, Indonesia. SUBJECTS Children (n 343) of mothers participating in a double-blinded, randomized controlled study of vitamin A and/or Zn supplementation during pregnancy. We report the effects of prenatal supplementation on infant growth, measured as weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and weight-for-height Z-scores (WHZ ), from 0 to 24 months, as well as differences in growth faltering among the supplementation groups. RESULTS For HAZ, the absolute differences between the vitamin A-only and vitamin A + Zn groups at 3 and 9 months were 0·34 SD and 0·37 SD, respectively, and the absolute difference between the vitamin A-only and Zn-only groups at 18 months was 0·31 SD. Compared with placebo, none of the supplements affected growth. Defining growth faltering as a downward crossing of two or more major percentile lines, 50-75% of the children were found to be growth faltering within 9 months of age, whereas 17% and 8% scored <-2 SD for WAZ and HAZ, respectively. Prenatal supplementation did not reduce the prevalence of growth faltering. CONCLUSIONS Prenatal vitamin A supplementation had a small but significant effect on postnatal growth of childrens length until 18 months of age compared with supplementation with either vitamin A + Zn or Zn alone, but not compared with placebo. It had no effects on other anthropometric measures and did not reduce the prevalence of growth faltering. Future studies should duplicate these findings before recommendations can be made.

46 XX Ovotesticular Disorder of Sexual Development with Detected SRY(Sexdetermining Region Y) Gene: A Case Report

Ovotesticular disorder or true hermaphroditism is a condition in which an individual has both ovary and testis. The ovary is usually located on the left side, whereas the testis is on the opposite side. The SRY gene is detected in one third of cases of 46 XX ovotesticular DSD. The most common karyotype of ovotesticular DSD is 46 XX. Here, we report the case of a girl with SRY positive 46 XX karyotype diagnosed as ovotesticular DSD by gonadal biopsy. The patient presented with female phenotype and ambiguous genital since birth. The external genital showed an accessoria penile without OUE with rough right labia majora that looked like scrotum. Testicle was felt on the right side of scrotum. USG revealed no appearance of normal uterus, right testicle was visualized but no visualization of left testicle. Right and left ovaries were not clearly visualized. Karyotyping-46 XX and SRY gene was detected on 472 bp fragment on multiplex PCR of AZF/SRY gene analysis. Diagnostic laparoscopy showed left hemiuterus with fallopian tube and unilateral left side ovary. The shape and size of left fallopian tube was normal. Histopathologic examination report revealed left gonad was ovarium with primary follicle and right gonad was testicle with leydig cell and seminiferous tubules. This patient was decided as a girl. The operation was initiated and divided into 2 phases. The first phase was orchidectomy of the right side testicle and the second phase was genital reconstruction (clitoroplasty and labioplasty).