RESUMO
Background: Blalock-Taussig (BT) is a palliative procedure that preserves blood circulation to the lungs and alleviates cyanosis in patients with congenital heart diseases and reduced pulmonary blood flow. BT shunt remains a routinely performed procedure in developing countries before definitive surgery. However, evidence on predictor factors of mortality after this procedure is still scarce in Indonesia. This study evaluated the predictive factors of mortality after the BT shunt procedure. Methods: This retrospective study evaluated the medical record data of all postoperative BT shunt patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from 2016 to 2020. We performed univariate and multivariate analyses to identify the predictors of in-hospital mortality. Results: The total subjects in this study were 197 children, 107 (54.3%) boys and 90 (45.7%) girls. The median values for age and body weight at the time of surgery were 20 months (11 days - 32 years) and 7.9 (2.7-42) kg. The most prevalent diagnosis was the Tetralogy of Fallot, found in 80 (40.6%) patients. In-hospital postoperative mortality was 20.8% (41 patients). Based on multivariate analysis, predictors associated with mortality were weight <4.25 kg (OR 20.9; 95% CI 7.4-59.0; p < 0.0001) and emergency procedures (OR 3.5; 95% CI 1.3-9.5; p = 0.016). Conclusion: The mortality rate after BT shunt at PJT Rumah Sakit Cipto Mangunkusumo was 20.8%. Based on multivariate analysis, weight <4.25 kg and emergency procedures are two predictors of mortality in BT shunt.
RESUMO
Background: Anemia is one of the major global problems that continues to this day. According to World Health Organization (WHO) data, anemia is found in 1.62 billion people or equivalent to 24.8% of the world's population while, the prevalence of anemia in children under 6 years of age in Indonesia reached 38.4%. Anemia, if undiagnosed or untreated for a long period of time can lead to multiorgan failure. The cardiovascular system is the most commonly affected system in chronic anemia. Between one-third and two-thirds of patients with severe anemia have cardiomegaly and this will return to normal within a few weeks after the anemia is well managed. This abnormality can be evaluated on chest radiograph or echocardiography. Objective: This study aims to evaluate the association between anemia and cardiomegaly. Methods: This was a cross-sectional which was carried out in the pediatric ward and pediatric cardiology outpatient clinic in the year 2022. The research subjects were children diagnosed with anemia, then they would undergo chest radiograph and echocardiography to assess whether there is cardiomegaly or not. Results: Eighty one children were included in this study. The majority of them were girl, with a total of 43 people (53.1%). The median age of patients in this study was 7.75 years old. In addition, this study also found that the median of patients' body weight and height were 18.3 kg and 116 cm. In this study, the median hemoglobin level was 10.3 g/dL. For the echocardiography parameters in this study, the median of LA/Ao, EF and FS were 1.24, 65% and 35% respectively.Conclusion There is no association beteween anemia and cardiomegaly based on chest radiograph or echocardiography.
RESUMO
Congenital heart disease (CHD) is a congenital disorder primarily affecting newborns and children. Children with CHD have a greater risk of experiencing growth delays or disorders compared to healthy children. CHD also affects various aspects of a child's development. The aim of this study was to determine the association of CHD types (cyanotic and acyanotic) with the growth and development status of children. A cross-sectional study was conducted among CHD patients at a national reference hospital in Sumatra, H. Adam Malik General Hospital in Medan, Indonesia. The children's growth status was assessed using the WHO growth chart, and the developmental condition was evaluated through the Denver Developmental Screening Test-II. Chi-squared test and Fisher's exact test were used to assess the association between the type of CHD with growth and development status in children. Using a consecutive sampling method, a total of 53 individuals were included in this study. Almost half of CHD patients (48.1%) were within the age group of 0-2 years and more than half (61.1%) were girls. Acyanotic CHD (74.1%) was more prevalent than cyanotic CHD (25.9%), with ventricular septum defect (VSD) as the most common diagnosis. A total of 37% of children with CHD suffered from malnutrition, whereas the remaining 62.9% had good nutrition. The Denver Developmental Screening Test-II indicated that 81.4% of the children were normal, whereas 18.5% had developmental disorders. Our data suggested a significant association between cyanotic CHD and poor growth status in children based on weight-for-age, weight-for-length, and body mass index (BMI)-for-age. However, there was no association between the type of CHD and developmental status in children. This study highlights that the type of CHD is significantly associated with the growth status of children, but not with their developmental status.
RESUMO
Background: Sepsis is a global health problem. Therapeutic agents continue to develop for the management of sepsis. Ascorbic acid and thiamine are currently potential agents intensively studied for their benefits in sepsis. Methods: This study was a randomized controlled trial (RCT) with a pretest-posttest control group design. Randomization was using a computer. The research was conducted at Haji Adam Malik General Hospital Medan and Grand Medistra Hospital. Blood tests were at the Integrated Laboratory of the Faculty of Medicine, University of North Sumatra. The research was for 14 months. The number of patients in this study was 86 septic patients divided into four groups (NaCl, thiamine, ascorbic acid, and combination). The parameters measured were the enzyme MMP-9 and the enzyme TIMP-1. Results: The number of subjects who met the inclusion criteria was 147 patients. Fifty-three patients passed away during the monitoring period, and eight blood samples were damaged. The final data analyzed consisted of 86 subjects. Of the 86 septic patients obtained Based on initial MMP-9 values, MMP-9 levels increased in the 0.9% NaCl group (25.6%), while MMP-9 levels decreased after intervention in the thiamine, ascorbic acid, and combination groups but a significant decrease in MMP-9 was found in the ascorbic acid group (17.2%; p = 0.04) and the combination group (17.9%; p = 0.026). For TIMP-1 levels, a decreasing trend was only in the ascorbic acid (5.1%) and combination (5.9%) but not significant (p > 0.05). The highest MMP-9/TIMP-1 ratio was in septic patients receiving thiamine with a significant linear correlation (p < 0.05) between levels of MMP-9 and the MMP-9/TIMP-1 ratio with a moderate correlation level and significant negative correlation (p < 0.05) between TIMP-1 and the MMP-9/TIMP-1 with a moderate level of correlation. Conclusion: Administration of thiamine alone gives better advantages than ascorbic acid alone and their combination.
