Distribution of maternal risk factors for orofacial cleft in infants in Indonesia: a multicenter prospective study

Background@#The pathogenesis of orofacial cleft (OFC) is multifactorial, involving both genetic and non-genetic factors, the latter of which play a key role in the development of these anomalies. This paper addresses the incidence of OFC in Indonesia, with a focus on identifying and examining the distribution of contributory factors, including parental medical history, pregnancy history, and environmental influences. @*Methods@#The study was conducted through the collection of primary data. An interdisciplinary research team from Indonesia administered a standardized questionnaire to parents who had children with OFC and who had provided informed consent. The case group comprised 133 children born with cleft lip and/or palate, and the control was 133 noncleft children born full-term. The risk factors associated with OFC anomalies were analyzed using the chi-square test and logistic regression. All statistical analyses were performed using SPSS version 25. A p-value of 0.05 or less was considered to indicate statistical significance. @*Results@#The study comprised 138 children, of whom 82 were boys (59.4%) and 56 were girls (40.6%). Among them, 45 patients (32.6%) presented with both cleft lip and cleft palate, 25 individuals (18.1%) had a cleft palate only, and 28 patients (20.3%) had a cleft lip only. OFC was found to be significantly associated with a maternal family history of congenital birth defects (p< 0.05), complications during the first trimester (p< 0.05), consumption of local fish (p< 0.05), caffeine intake (p< 0.05), prolonged medication use (p< 0.05), immunization history (p< 0.05), passive smoking (p< 0.05), and X-ray exposure during pregnancy (p< 0.05). @*Conclusion@#The findings indicate close relationships between the incidence of OFC and maternal medical history, prenatal factors, and environmental influences.

ZnO-Enhanced Reduced Graphene Oxide Electrodes from Cocoa Shell: Nanoarchitectonics Platform for Photoelectrocatalytic Detection of Methylene Blue.

In this study, we report the successful preparation of reduced graphene oxide modified zinc oxide (rGO-ZnO) composites from cocoa shells. Synthesis of rGO-ZnO was carried out using the Hummer method and thermal reduction. The electrode material was comprehensively characterized using fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and scanning electron microscopy & Energy Dispersive X-ray (SEM-EDX). The photoelectrocatalytic performance of the prepared composite electrodes was evaluated using various electrochemical techniques, including Linear Sweep Voltammetry (LSV), Cyclic Voltammetry (CV), and Multi Pulse Amperometry (MPA). The FTIR analysis of rGO-ZnO exhibited distinct bands corresponding to C-O at 1022 cm-1, C=C at 1600 cm-1, and Zn-O at 455 cm-1. The XRD analysis revealed characteristic peaks at 26.6º, 29.2º, 36.2º, 44.04º, 47.58º, and 64.4º, confirming the presence of key crystalline phases. SEM-EDX analysis of rGO-ZnO revealed a rough surface morphology with bright white and black regions, signifying the coexistence of ZnO and rGO with carbon, oxygen, and zinc contents of 78.98%, 17.46%, and 3.56%, respectively. The investigations involved the photoelectrochemical profiles of methylene blue organic dyes at different concentrations, ranging from 0.5 ppm to 3.0 ppm. The acquired findings offer valuable understanding into the photoelectrocatalytic effectiveness of the composite electrodes containing rGO-ZnO, suggesting their potential use in potential scenarios involving the revitalization of the environment in industrial water systems.

Occult Kidney Dysfunction in Children With Transfusion-Dependent Thalassemia.

Background: Thalassemia is the commonest hemoglobinopathy in Southeast Asia. Kidney dysfunction is an underreported sequelae in children with thalassemia. We conducted a retrospective study to identify the prevalence of and predisposing factors for kidney dysfunction in children with transfusion-dependent thalassemia (TDT). Method: Abnormal kidney function was defined as children with a glomerular filtration rate (GFR) of <90 ml/min/1.73 m2 or a decline in GFR of >20 ml/min/1.73 m2 or presence of nephrotic range proteinuria within 3 years of commencing regular (every ≤6 weeks) red cell transfusion. Data analyzed were age at diagnosis of thalassemia, number of transfusion-years, iron chelation therapy, serum ferritin, and pre-transfusion hemoglobin levels. Results: Eighty-one children were studied. Mean age was 11.72 ± 5.275 years. Thirty out of 81 (37%) demonstrated abnormal kidney function. Evidence of glomerular hyperfiltration was seen in 29/81 patients (25.85%) at their last clinic visit. This fraction was doubled [48/81 (59.3%)] when the cohort was tracked back by 3 years from the last clinic encounter. Age at diagnosis (RR, 1.157; 95% CI, 1.014-1.319; p = 0.03) and duration of receiving transfusions (RR, 0.984; 95% CI, 0.974-0.994; p = 0.001) were associated with increased risk of developing abnormal kidney function. Conclusion: Abnormal kidney function in children with TDT may be overlooked by medical personnel without active screening measures. Children receiving regular red cell transfusions require systematic surveillance to enable early detection of kidney dysfunction and timely implementation of appropriate therapeutic interventions.

Case Report: Severe Hyponatremia in Infants With Urinary Tract Infection.

Introduction: Many reports on investigations and treatments in UTI, however little, have been mentioned with regard to electrolyte abnormalities. Secondary pseudohypoaldosteronism (PHA) in UTI, though less common, is a known association. Features include hyponatremia and concomitant hyperkalemia. Objectives: We aim to highlight these uncommon sequelae in UTI to avoid incorrect diagnosis and unnecessary investigations. Study Design: Clinical data of patients admitted and referred to a pediatric nephrologist at the University Malaya Medical Center between May 2019 and October 2020 were collated and elaborated. Results and Discussion: We report three infants with hyponatremia and hyperkalemia during UTI episodes. Two infants were known to have posterior urethral valve (PUV) before the onset of UTI and one infant had UTI, which led to investigations confirming the diagnosis of bladder vaginal fistula. The electrolyte derangements were temporary and resolved within 48 to 72 h of treatment with intravenous fluid and appropriate antibiotic therapy. Out of three, only one had a hormonal study, which confirms PHA. Reduced aldosterone activity could be due to absolute reduction in aldosterone titer or lack of aldosterone responsiveness at tubular (other tissues) level. In the latter, aldosterone titer is elevated. The infant in our cohort who had hormonal evaluation had the mentioned electrolyte abnormalities with a markedly elevated aldosterone titer. This demonstrated defective action of the hormone at the level of mineralocorticoid receptor. Although the remaining two infants had no confirmatory hormonal study, all of them recovered within 48 h of hospital admission, after receiving appropriate management for the primary problem, which was UTI. We observed a slower recovery of hyponatremia in relation to hyperkalemia, but none of these infants required salt replacement upon discharge. Conclusion: Infants with severe UTI and deranged electrolytes should be screened for structural abnormality and vice versa. Not all infants require hormonal screening, but those who required prolonged salt replacement or showed involvement of other systems warrant further evaluation.