Ponpon Idjradinata

Association of complex lipids containing gangliosides with cognitive development of 6-month-old infants

BACKGROUND Human breastmilk contains gangliosides which may play an important role in infant neurodevelopment. AIM A pilot study was conducted to assess the impact of infant formula supplemented with gangliosides from complex milk lipid on cognitive functions of normal healthy infants. STUDY DESIGN The study was a double-blind, randomized, controlled, parallel group clinical trial in which infants received the treatment or control product from 2 to 8 weeks of age until 24 weeks of age. The control group (n=30) received standard infant formula and the treatment group (n=29) received the same formula supplemented with complex milk lipid to increase the ganglioside content to approximately 11 to 12 μg/ml. A reference group (n=32) consisted of normal healthy exclusively breast-fed infants. OUTCOME MEASURES Cognitive development using the Griffith Scales and serum gangliosides was measured before (2-8 weeks of age) and after intervention (24 weeks of age). RESULTS Ganglioside supplementation using complex milk lipids significantly increased ganglioside serum levels (control group vs treatment group, P=0.002) and resulted in increased scores for Hand and Eye coordination IQ (P<0.006), Performance IQ (P<0.001) and General IQ (P=0.041). Cognitive development scores and serum ganglioside levels for the treatment group did not differ from the reference group. CONCLUSIONS Supplementation of infant formula with complex milk lipid to enhance ganglioside content appears to have beneficial effects on cognitive development in healthy infants aged 0-6 months, which may be related to increased serum ganglioside levels.

Early resuscitation of dengue shock syndrome in children with hyperosmolar sodium-lactate: a randomized single-blind clinical trial of efficacy and safety

IntroductionDengue shock syndrome (DSS) fluid resuscitation by following the World Health Organization (WHO) guideline usually required large volumes of Ringer lactate (RL) that might induce secondary fluid overload. Our objective was to compare the effectiveness of the recommended volume of RL versus a smaller volume of a hypertonic sodium lactate solution (HSL) in children with DSS. The primary end point was to evaluate the effect of HSL on endothelial cell inflammation, assessed by soluble vascular cell adhesion molecule-1 (sVCAM-1) measurements. Secondarily, we considered the effectiveness of HSL in restoring hemodynamic fluid balance, acid-base status, and sodium and chloride balances, as well as in-hospital survival.MethodsA prospective randomized single-blind clinical trial including 50 DSS children was conducted in the Pediatrics Department of Hasan Sadikin Hospital, Bandung, Indonesia. Only pediatric patients (2 to 14 years old) fulfilling the WHO criteria for DSS and new to resuscitation treatments were eligible. Patients were resuscitated with either HSL (5 ml/kg/BW in 15 minutes followed by 1 ml/kg/BW/h for 12 hours), or RL (20 ml/kg/BW in 15 minutes followed by decreasing doses of 10, 7, 5, and 3 ml/kg BW/h for 12 hours).ResultsIn total, 50 patients were randomized and included in outcome and adverse-event analysis; 46 patients (8.2 ± 0.5 years; 24.9 ± 1.9 kg; mean ± SEM) completed the protocol and were fully analyzed (24 and 22 subjects in the HSL and RL groups, respectively). Baseline (prebolus) data were similar in both groups. Hemodynamic recovery, plasma expansion, clinical outcome, and survival rate were not significantly different in the two groups, whereas fluid accumulation was one third lower in the HSL than in the RL group. Moreover, HSL was responsible for a partial recovery from endothelial dysfunction, as indicated by the significant decrease in sVCAM-1.ConclusionSimilar hemodynamic shock recovery and plasma expansion were achieved in both groups despite much lower fluid intake and fluid accumulation in the HSL group.Trial RegistrationClinicalTrials.gov NCT00966628. Registered 26 August 2009.

Hubungan Subtipe Sel Limfosit dengan Tingkat Remisi Pascakemoterapi Fase Induksi Leukemia Limfoblastik Akut

Latar belakang . Angka remisi pascakemoterapi LLA masih belum memuaskan, banyak faktor yang memengaruhi belum optimalnya luaran terapi LLA, salah satunya adalah faktor subtipe sel limfosit LLA. Tujuan . Melihat hubungan subtipe sel limfosit dengan tingkat remisi pascakemoterapi fase induksi LLA. Metode . Penelitian kohort prospektif dilakukan di RS dr. Hasan Sadikin Bandung dari bulan Februari-September 2016. Subyek adalah anak <14 tahun yang baru didiagnosis LLA berdasarkan hasil aspirasi sumsum tulang. Diambil sampel darah perifer untuk dilakukan pemeriksaan immunophenotyping agar dapat diketahui subtipe sel limfositnya, dilakukan kemoterapi fase induksi selama 6 minggu berdasarkan protokol terapi. Dilakukan aspirasi sumsum tulang evaluasi untuk melihat tingkat remisinya. Analisis statistik dilakukan dengan uji Fisher-exact. Hasil . Terdapat 40 subjek yang memenuhi kriteria inklusi dan menjalani kemoterapi fase induksi. Dari 40 subjek, 26 menyelesaikan kemoterapi fase induksi, dan dari 26 subjek yang dilakukan evaluasi aspirasi sumsum tulang, 20/26 mengalami remisi lengkap dan 6/26 tidak remisi. Terdapat 18/24 subjek sel B-LLA yang mengalami remisi lengkap dan 6/24 tidak remisi, sedangkan penderita sel T-LLA yang mengalami remisi lengkap 2/2 subjek. Tidak terdapat perbedaan yang bermakna antara subtipe sel limfosit dengan tingkat remisi pascakemoterapi fase induksi (p=0,585). Kesimpulan . Subtipe sel limfosit tidak berpengaruh terhadap tingkat remisi pascakemoterapi fase induksi.

A Case of Perforation of the Gallbladder in Association with Typhoid Fever

The purpose of this paper is to report a case of rupture of gallbladder in a child in association with typhoid fever.

Interleukin-18 correlates with interleukin-4 but not interferon-gamma production in the lymphocyte cultures of atopic dermatitis patients after staphylococcal enterotoxin B stimulation.

BACKGROUND Staphylococcus aureus (S. aureus) triggers exacerbation of atopic dermatitis (AD) and causes chronic inflammation through the action of various proteins such as staphylococcal enterotoxin B (SEB). SEB has a role in activating interleukin (IL)-18, an important regulator of interferon (IFN)-γ and IL-4, in regards to a therapeutic strategy. OBJECTIVE To determine the correlation of IL-18 level with the IL-4 and IFN-γ level in lymphocyte cultures from AD patients following SEB stimulation. METHOD Twenty patients with AD based on the Hanifin and Rajka criteria and 20 healthy subjects as a control group were selected. A 5 ml blood sample from each subject was taken for lymphocyte culture. The culture was stimulated with SEB for two days and the outcomes were assessed by enzyme-linked immunosorbent assays (ELISA) to evaluate the levels of IL-18, IL-4, and IFN-γ. RESULTS In the AD group, the levels of IL-18, IL-4, and IFN-γ in lymphocyte cultures with SEB were significantly increased compared with non-SEB exposed cells (each p<0.001); similar results were found in the control group. The level of IL-18 was significantly elevated in lymphocyte cultures with SEB stimulation in AD vs. control (p<0.05) and without SEB in AD vs. control (p<0.05). Furthermore, IL-18 levels were significantly correlated with IL-4 levels and score atopic dermatitis (SCORAD) values in AD patients with SEB (r=0.41, p<0.05; and r=0.70, p<0.05, respectively); on the in contrary, there was no correlation between IL-18 and IFN-γ levels (p=0.469). CONCLUSIONS Our results suggest that IL-18 is correlated with increased of IL-4 levels in SEB-stimulated AD lymphocyte cultures.