ABSTRACT
Purpose: Volume measurement in critically ill children can be conducted using invasive procedure such as Central Venous Pressure (CVP), or non-invasive procedure such as measurement of Inferior Vena Cava (IVC) indices using ultrasonography. However, their accuracy and efficacy are still under scrutiny. We aim to compare CVP and IVC indices as non-invasive parameters in assessing volume status in critically ill children. Methods: We conducted a systematic review based on literature searching from four electronic databases which were PubMed, Cochrane, ScienceDirect, SpringerLink with keywords: "CENTRAL VENOUS PRESSURE", "INFERIOR VENA CAVA DIAMETER", "INFERIOR VENA CAVA COLLAPSIBILITY", "INFERIOR VENA CAVA AORTIC-RATIO", "VOLUME STATUS", "FLUID STATUS", "CRITICAL ILL", "CHILDREN", and "PEDIATRICS". We included relevant studies in English published from 2000 to 2023 on critically ill children aged 0-18 years. Comparison between CVP and IVC indices was resumed. Results: Eight articles were included in this study. Majority of the studies showed a consistent correlation between CVP and IVC indices. IVC-CI was the most common parameter evaluated in the included studies. There was moderate to strong correlations using IVC-CI and IVC-DI, and moderate correlation using IVC-Ao ratio. Conclusion: We found that non-invasive tools might have a potential role to measure volume in critically ill children equals to CVP. Further high-quality and longitudinal studies are needed to validate these findings and to establish a clear guideline for the non-invasive tool to be used in daily clinical practice.
ABSTRACT
Introduction: As the highest function in the brain that regulates our daily activity, executive dysfunction might affect someone's health-related quality of life (HRQoL), especially in those with chronic diseases, including chronic kidney disease (CKD). Neurocognitive functions, including intelligence quotient (IQ) and executive function can be affected through various mechanisms in CKD. However, there was still no specific study regarding how IQ and executive function might affect HRQoL in children with CKD. Purpose: To assess Executive Function's impact on HRQoL and to find association between treatment modalities and CKD stages with HRQoL in children with CKD. Methods: A cross sectional study was conducted at Pediatric Nephrology Clinic at Hasan Sadikin General Hospital, Bandung, Indonesia from September 2022 to April 2023. We included 38 children whose age range were 6-16 years 11 months old with CKD stage III - V. Assessment tools used were: BRIEF questionnaire for executive function; WISC III tool for IQ; PedsQLTM questionnaire generic module for HRQoL. Data was analyzed using SPSS ver. 26.0. Results: Total number of samples was 38. Complete examinations were done on 30 patients. Eight other patients did not undergo the IQ test. There was a negative correlation between executive function components scores (GEC, BRI, MI) with HRQoL scores on parents' proxy in all domains. We found no correlation between HRQoL and IQ scores, but we found a correlation between IQ and CKD stage. There was a significant difference in HRQoL from the children's perspective among the three modalities; children who underwent conservative treatment were having the best HRQoL scores. Conclusion: Interventions to improve executive function of children with CKD should be done to improve their HRQoL in the future. Early diagnosis and treatment of CKD should be done at the earliest to improve neurocognitive function and HRQoL.
ABSTRACT
We report a case of a 5-year-old girl who came to Otolaryngology Outpatient Clinic of our hospital with the chief complaint of recurrent ear discharge which had started to appear since 3 years ago and had recurred every month despite repeated antibiotics and antifungals ear drops treatments, given by general practitioners and otolaryngologists. Gram staining, acid-fast staining and Mycobacterium tuberculosis culture examination from the discharge had never been conducted. There was a history of inadequate weight increment since she was 2 years old. Her uncle who often met her died about 6 months ago due to TB disease. She was initially diagnosed with otitis media from the previous clinicians before finally referred to our hospital due to the perforated tympanic membrane. Otoscope examination showed perforated tympanic membrane. CT scan showed right osteomastoiditis with cholesteatoma with destruction of right mastoid antrum and right ear bone. We did not find pale-looking granulomatous tissue or multiple perforated tympanic membrane. The patient was diagnosed with chronic suppurative otitis media (CSOM) of the right ear with right mastoiditis and right posterior auricle fistulae. Afterwards, canal wall up, canaloplasty, mastoid obliteration, tympanoplasty, and rotational flap right ear were performed. Histopathology examination revealed the presence of caseous necrosis and datia langhans cells. Based on her chronic illness supported by the histopathological findings, anti-tuberculosis therapy was commenced. No more ear discharge complained and her body weight started to increase after oral anti tuberculosis treatment.
