Tiangsa Sembiring

Association between oxygen saturation and critical congenital heart disease in newborns

Background Critical congenital heart disease (CCHD) is relatively common, with a prevalence of 6-8 in every 1,000 live births. This congenital anomaly is a newborn condition that would be ideally suited for a screening program, if simple and reliable methods were available. Pulse oximetry (PO) has been proposed as a screening method to detect CCHD. Objective To assess for a possible association between decreased oxygen saturation and CCHD in newborns. Methods We conducted a cross-sectional study from March 2014 to February 2015 in several hospitals in North Sumatra. Healthy, full term and post-term newborns aged 2 to 72 hours underwent pulse oximetry measurements on the right hand and one of the lower extremities. If oxygen saturation (SpO2) was ≤ 95%, the measurement was repeated 2 more times. Subjects also underwent echocardiography. Results A total of 386 newborns underwent SpO2 measurements: 377 newborns had SpO2 > 95% and 9 newborns had SpO2 ≤ 95%. Of the infants with SpO2 > 95%, 297 were excluded because their parents refused echocardiography examination. Thus, 80 newborns with SpO2 > 95% and 9 newborns with SpO2 ≤ 95% underwent echocardiography. Echocardiography revealed that 5 of 9 newborns with SpO2 ≤ 95% suffered from Tetralogy of Fallot (ToF) (3 subjects) and transposition of the great arteries (TGA) (2 subjects). One infant with SpO2 > 95% had ventricular septal defect (VSD), as detected by echocardiography. Oxygen saturation ≤ 95% had significant association with CCHD (P<0.001). Conclusion Decreased oxygen saturation has a significant association with critical congenital heart disease in newborns. [Paediatr Indones. 2018;58:90-4; doi: http://dx.doi. org/10.14238/pi58.1.2018.90-4].

Correlation of nutritional status with academic achievement in adolescents

Malnutrition is considered a problem that limits learning ability (cognitive function), which is related to poor academic achievement results. This study aimed to determine the relationship of nutritional status with academic achievement in adolescents. A cross-sectional study was conducted on 126 junior high school students ranging from 12 to 15 years in Batubara, North Sumatra in January 2015. Nutritional status is determined by weight for height. Academic achievement was recorded from the final results of their school exams. The value of intelligence quotient (IQ) was assessed by using the Aptitude Test. Data were then analyzed by using Spearman correlation and Chi-Square test. In conclusion, there was no significant difference between nutritional status with IQ score (p=0,540) but showed a significant relationship (p=0.003) between normal nutritional status with the total value of the report card with positive weak correlation strength (r=0.342). There was also a significant difference (p=0.020) and moderate positive correlation (r=0.541) between overweight with academic achievement based on mathematics.

Hemolytic anemia in falciparum and vivax malarial patients based on serum bilirubin examination

Objective To examine hemolysis in falciparum and vivax malarial patients based on serum bilirubin examination. Methods A cross sectional study was conducted on children younger than 15 years of age who visited public health center in the district of Mandailing Natal with complaints of fever, shivering, pale, jaundice, diarrhea, or headache between April 9 th and April 19 th 2001. Variables recorded were age, gender, body weight, body height, symptoms and signs, anti malarial drugs, and laboratory test results. Thin and thick blood smears were done as diagnostic tools of malaria. Thin blood smear was also performed to deter- mine the level of malaria parasites in blood (parasitemia) and to examine the morphology of red blood cells. Hemolysis was deter- mined by bilirubin examination. Results In P. falciparum malaria, there was a moderate correlation (r=0.68, p<0.0001) between parasitemia and indirect bilirubin con- centration. While in P. vivax malaria, there was only a weak corre- lation (r=0.46, p=0.007) between parasitemia and indirect bilirubin concentration. It was also found that in falciparum malaria, para- sitemia, total and indirect bilirubin concentrations were significantly higher than that in vivax malaria, with p values of 0.009, 0.015 and 0.003, respectively. Conclusion Hemolysis in falciparum malaria is more severe than that in P. vivax malaria, with marked elevation of indirect bilirubin. The elevation of serum bilirubin correlated with parasitemia

Body mass index, atopy, and allergic diseases

Background Prevalence of atopy, allergic diseases, and obesity are increasing. Atopy is an individu and/or familial tendency to sensitization in response to ordinary exposure to allergens. Studies on association of BM I with atopy and allergic diseases in children were limited, with inconclusive results. Objective To assess associations of BM I with atopy and allergic diseases in chidren. Methods A cross-sectional was conducted in school children aged 6-12 years in Lhokseumawe City, Aceh, June 2012. Children were assessed for BMI, skin prick test, and International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Statistical analyses included Chi-square, Fisher exact, and logistic regression. Results The subjects consisted of 137 (85.6%) normoweight, 12 (7.5%) overweight, and 11 (6.9%) obesity. Skin prick test results were positive in 44 (27.5%) and negative in 116 (72.5%) subjects. Allergic manifestations were allergic rhinitis (AR) 17 (10.6%), bronchial asthma 6 (3.8%), and atopic dermatitis (AD) 3 (1.9%). There was significant association of obesity with atopy, compared with normoweight (OR=3.78; 95%CI 1.08 to 13.19; P=0.037), but no significant association found when family history of atopy also assesed. There was significant association of obesity with bronchial asthma (OR=9.92; 95%CI 1.46 to 67.18; P=0.004) and AR (OR=6.49; 95%CI 1.64 to 25.66; P=0.015), compared with normoweight children. Significant association of overweight with atopy and allergic disease were not found. Conclusion Obese children are more likely to have atopy, bronchial asthma, and allergic rhinitis, but overweight and normoweight children are not.

Nutritional status and malaria infection in primary school-aged children

Background The most common nutritional problem affecting the pediatric population in developing countries is protein energy malnutrition (PEM). The nutritional problem may be caused by a variety of factors, most of which are related inadequate food intake and infection. One of the highest causes of morbidity and mortality in endemic areas is malaria. Malaria infection and nutritional status have been suggested to be interrelated. Objective To assess for a relationship between nutritional status and malaria infection in children. Methods This cross-sectional study was conducted in October and November 2010 in primary school children at Panyabungan City, North Sumatera Province. Peripheral thick and thin blood smear examinations were done to confirm the diagnosis of malaria. Participants were divided in two groups (malaria-infected and uninfected) by consecutive sampling. Nutritional status was determined by body weight and height measurements based on the 2000 Centers for Disease Control and Prevention (CDC) chart. The mild and moderate malnutrition classification was further sub-divided into stunted and wasted, based on the 2007 NCHS/WHO chart. Chi-square test was used to analyze the relationship between nutritional status and malaria infection. Results There were 126 children in each group. Significant differences in mild-moderate malnutrition were found between the malaria-infected and uninfected groups (23.8% vs. 46.8%, respectively; P= 0.011). There were also significant differences between the malaria-infected and uninfected groups with regards to chronic malnutrition type: stunted (20.0% vs. 37.3%, respectively; P=0.042) and stunted-wasted (6.7% vs. 28.8%, respectively; P= 0.008) in both groups of the children with mild-moderate malnutrition. Conclusion There are significantly more children with mild-moderate malnutrition in the uninfected group than in the malaria-infected group, furthermore, of those with mild-moderate malnutrition, there are significantly more stunted and stunted-wasted children who were uninfected than malaria-infected.

School performance in pubertal adolescents with dysmenorrhea

Background Dysmenorrhea is a common gynecological symptom reported in adolescent girls. Prevalence of the condition has been reported to be 45 - 75%. Absenteeism from work and school as a result of dysmenorrhea is common (13 - 51% of women have been absent at least once, and 5 - 14% are often absent due to the severity of symptoms). Objective To compare school performance in pubertal adolescent girls with and without dysmenorrhea. Methods This cross-sectional study was conducted in June 2010 in adolescent females aged 12 - 18 years from the Musthafawiyah School, Mandailing Natal district, North Sumatera. Adolescent females with and without dysmenorrhea were recruited for this study. All participants completed questionnaires including age of menarche, length of menstrual cycle, length of bleeding, number of sanitary napkins used daily and school absences. School reports from two consecutive semesters in one year were used to evaluate subjects’ academic performance. An academic score of higher than 7.5 was considered good performance while scores of less than 7.5 were considered poor. We used the chi-square test to analyze differences in school performance between girls with and without dysmenorrhea. Results One hundred and sixteen participants were divided into 2 groups, those with and without dysmenorrhea, of 58 subjects each. We found no significant difference in school performance between the two groups, P=0.176 (95% CI -0.009 to -0.048 and P=0.08 (95%CI -0.052 to 0.024). Conclusion There was no significant difference in school performance of girls with and without dysmenorrhea.

Albendazole versus combined pyrantel pamoate-mebendazole in the treatment of mixed infection of soil-transmitted helminthiasis

Background Soil transmitted helminthiasis is still highly prevalent in Indonesia, especially in rural area and among poor socio-economic population. Helminthiasis is frequently found as a single or mixed infection. It is difficult to get a medication with better efficacy, low cost, and simple administration for all types of worms. Objective The aim of this sudy was to compare the effectiveness of albendazole and pyrantel pamoate-mebendazole combination in treating soil-transmitted helminthiasis. Methods A randomized clinical trial was perionned in September until November 1995 on students of a primary school in Tanjung Anom Village whose stool examinations showed mixed infection of helminthiasis. Subjects were randomly allocated into two groups. The A group was treated with 400 mg oral albendazole as a single dose, while the B group was treated with the combination of pyrantel pamoate 10 mg/kg body weight as a single dose and mebendazole 100 mg twice a day for three consecutive days. Cure was considered if in the stool examination, no wonn eggs were found. Statistical analysis was periormed by Chi-square test with confidence interval of 95% and p value of < 0.05 was considered significant. Results Out of 541 children, mixed infection of soil-transmitted helminthiasis was found in 374 children (69%). Three hundreds sixty-six children completed the study, consisted of 182 children in group A and 184 in group B. At 3 weeks after treatment, the cure rate in the A group was significantly better compared to that in B group. Conclusions Albendazole was more effective than the combination of pyrantel pamoate - mebendazole for treating mixed infection of soil-transmitted helminthiasis. Besides the administration was simpler and caused minimal side effect.