Max Mantik

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 childs health was beyond doctor control and determined by luck, fate or God (55%). Causes of cancer were thought to be destiny (35%) or Gods 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 childs 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.

Health‐care providers' perspectives on childhood cancer treatment in Manado, Indonesia

Childhood cancer survival in low‐income countries is low.

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

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.

ROLE OF THROMBOMODULIN IN DETECTION OF ENDOTHELIAL CELL DESTRUCTION AFTER INFECTION WITH FALCIPARUM AND TERTIAN MALARIA

INTRODUCTION: Thrombomodulin is an endothelial cell receptor for thrombin. In tropical and tertian malaria, thrombomodulin is secreted after endothelial cell destruction after infections with Plasmodium falciparum or Plasmodium vivax. OBJECTIVE: Our goal was to investigate whether thrombomodulin levels can be used to detect the endothelial cell destruction after tropical or tertian malaria and whether thrombomodulin is related to the severity of tropical malaria. METHODS: This was a cross-sectional observational analytical study conducted in 5 hospitals in north Sulawesi, Indonesia, from June to September 2006, in patients aged 2 to 13 years with tropical or tertian malaria. Thrombomodulin levels were determined with an enzyme-linked immunosorbent assay using a thrombomodulin kit (Fujirebio Diagnostics, Inc, Malvern, PA). Data were analyzed by independent t test and Spearman rank correlation coefficient. RESULTS: For 30 patients with tropical malaria (thrombomodulin level: 0.060–0.180 FU/mL) and 2 patients with tertian malaria (thrombomodulin level: 0.068–0.075 FU/mL), there was a significant difference in t-test results between tropical and tertian malaria (P = .044). For 11 patients with severe malaria (thrombomodulin level: 0.086–0.162 FU/mL), there was also a very significant difference in t-test results for complicated and uncomplicated tropical malaria (P = .009). The Spearman rank test showed significant positive correlation between thrombomodulin and parasitemia levels (rs = 0.686; P = .001). CONCLUSIONS: Thrombomodulin levels can be used to detect endothelial cell destruction in malaria; the thrombomodulin level in tropical malaria was found to be higher than that of tertian malaria. Thrombomodulin levels were very significantly different in complicated and uncomplicated tropical malaria and also correlated significantly with the degree of parasitemia.

Peran Interleukin-6 Dalam Menilai Respon Pengobatan Pada Sepsis Neonatorum Awitan Dini

Latar belakang . Interleukin-6 memiliki potensi untuk menilai respon pengobatan selain sebagai biomarker sepsis. Tujuan . Menentukan peran IL-6 dalam mengevaluasi respon pengobatan pada sepsis neonatorum awitan dini (SNAD). Metode . Kami melakukan penelitian potong lintang dengan sampel SNAD yang memenuhi kriteria penelitian dengan jumlah sampel sebanyak 40 bayi dan mendapatkan informed consent dari orang tua serta persetujuan komite etik RSUP Kandou. Analisis data menggunakan uji Wilcoxon dan uji t berpasangan. Hasil . Dari 40 sampel, terdapat 12 bayi laki-laki dan 3 bayi perempuan mengalami respon buruk. IL-6 sebelum dan sesudah terapi antibiotik pada kelompok respon baik memiliki nilai median 16,32 (Qd 5,23) dan 0,56 (Qd 0,46). Kelompok respon buruk memiliki nilai rerata IL-6 120,89 (SB 87,35) dan 503,71 (SB 479,97). Hasil uji Wilcoxon menyatakan penurunan IL-6 yang sangat bermakna terhadap kelompok respon baik (p<0,0001), begitu juga pada kelompok respon buruk terjadi peningkatan yang sangat bermakna dengan hasil uji t berpasangan (p=0,004). Kesimpulan . IL-6 merupakan biomarker yang dapat dipertimbangkan untuk menilai respon pengobatan pada SNAD, IL-6 akan menurun jika diberikan antibiotik yang tepat.

Efektifitas Suplementasi Besi Harian Dibandingkan Mingguan pada Anemia Defisiensi Besi Anak Umur 5 – 11 Tahun

Latar belakang. Anemia defisiensi besi (ADB) sering ditemukan pada anak usia sekolah. Pengobatan yang utama adalah mengatasi faktor penyebab dan pemberian zat besi. Ketidakpatuhan minum obat merupakan masalah utama pada strategi suplementasi besi harian sehingga dipikirkan untuk diberikan secara mingguan. Tujuan. Untuk mengetahui efektifitas suplementasi besi harian dibandingkan mingguan pada anak dengan ADB. Metode. Penelitian eksperimen komparatif dengan rancangan the pretest-posttest two group design dilakukan pada 40 anak berumur 5-11 tahun dengan ADB. Kelompok I mendapatkan suplementasi besi harian (sulfat ferosus) dan kelompok II mendapat suplementasi besi mingguan selama 2 bulan. Sebelum dan sesudah suplementasi besi, dilakukan pemeriksaan hemoglobin, MCHC, besi serum, dan kapasitas pengikat besi total. Hasil. Tidak ada perbedaan signifikan antara suplementasi besi harian dibandingkan mingguan pada perubahan hemoglobin, MCHC, besi serum, dan kapasitas pengikat besi total (p>0,05). Kesimpulan. Suplementasi besi harian sama efektifnya dengan mingguan dalam pengobatan anemia defisiensi besi

Efektivitas Penambahan Seng dan Vitamin A pada Pengobatan Anemia Defisiensi Besi

Latar Belakang. Prevalensi anemia defisiensi besi (ADB) masih tinggi di Indonesia. Prinsip tata laksana anemia adalah mencari penyebab, mengatasinya, memberikan terapi besi dan pencegahan. Beberapa zat berinteraksi baik dengan besi. Interaksi antara besi dan seng dan besi dengan vitamin A telah terbukti pengaruhnya terhadap anemia. Tujuan. Untuk mengetahui apakah pemberian besi + seng + vitamin A pada ADB lebih efektif meningkatkan kadar Hb dan retikulosit dibandingkan besi saja. Metode. Menggunakan pretest and posttest control group design secara tersamar tunggal pada anak usia 5-11 tahun dengan ADB di beberapa panti asuhan di Manado dari Desember 2006-Maret 2007. Dibagi atas dua kelompok Kelompok I mendapat besi + vitamin A + seng dan kelompok II mendapat besi dan plasebo. Hasil. Perbandingan kadar Hb setelah terapi antar ke-2 kelompok didapatkan perbedaan bermakna (p 0,05). Kesimpulan. Pemberian besi + vitamin A + seng efektif meningkatkan kadar Hb dibandingkan besi saja.

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

Hemangiomas are the most frequent vascular tumors observed in early childhood. The presentation is unique, with an initial phase of proliferation, followed by a phase of slow, spontaneous regression after the age of 1 year.1,2 Most hemangiomas are uncomplicated and do not require intervention. However, therapy may be needed if the hemangioma is located at certain body sites, such as the face, or if it results in a functional handicap, such as limitation of eye opening. In addition, ulcerated, rapidly growing hemangiomas may require treatment.3