Cross-sectional echocardiographic measurement of right atrial and right ventricular size in children with atrial septal defect before and after surgery

Summary A total of 25 children operated on for atrial septal defect were studied by cross-sectional echocardiography before and after operation. Right atrial and right ventricular dimensions and areas were measured preoperatively and 1–4 years (median, 32 months) postoperatively. The length, width, and area of the right atrium (RA) and the right ventricle (RV) were measured in the apical and the subcostal four-chamber views. The dimension of the RV outflow tract (RVOT) was measured in the parasternal short-axis view.Preoperatively, all group mean values except the subcostal four-chamber length of the RV were significantly larger than normal.After surgery, there was a significant decrease in all of the parameters studied, except for RV length. The mean postoperative values of RA measurements in the apical four-chamber view and of RVOT were still significantly larger than normal. The RV four-chamber measurements except the apical four-chamber length were not significantly enlarged. The greatest decrease in RA and RV size occurred in the first postoperative year. Longer follow-up periods did not change the measurements significantly.     

Introducing Vi polysaccharide typhoid fever vaccine to primary school children in North Jakarta, Indonesia, via an existent school-based vaccination platform

OBJECTIVES: To report results on coverage, safety and logistics of a large-scale, school-based Vi polysaccharide immunization campaign in North Jakarta. METHODS: Of 443 primary schools in North Jakarta, Indonesia, 18 public schools were randomly selected for this study. Exclusion criteria were fever 37.5 degrees C or higher at the time of vaccination or a known history of hypersensitivity to any vaccine. Adverse events were monitored and recorded for 1 month after immunization. Because this was a pilot programme, resource use was tracked in detail. RESULTS: During the February 2004 vaccination campaign, 4828 students were immunized (91% of the target population); another 394 students (7%) were vaccinated during mop-up programmes. Informed consent was obtained for 98% of the target population. In all, 34 adverse events were reported, corresponding to seven events per 1000 doses injected; none was serious. The manufacturer recommended cold chain was maintained throughout the programme. CONCLUSIONS: This demonstration project in two sub-districts of North Jakarta shows that a large-scale, school-based typhoid fever Vi polysaccharide vaccination campaign is logistically feasible, safe and minimally disruptive to regular school activities, when used in the context of an existing successful immunization platform. The project had high parental acceptance. Nonetheless, policy-relevant questions still need to be answered before implementing a widespread Vi polysaccharide vaccine programme in Indonesia.     

The influence of diabetes and or periodontitis on inflammation and adiponectin level

BackgroundIn Indonesia, most of diabetic patients had periodontitis and 75.3% of them had severe periodontitis. Previous study found that hyperglycemia and or local inflammation (such as periodontitis) modulated systemic pro-inflammatory and anti-inflammatory cytokines.AimsThis study aimed to investigate the effect of DM and or periodontitis on systemic cytokines and adipocytokines levels.Methods and materialsA total of 57 participants with age of 29–71 years were recruited for this study. We divided them into three groups; DM-periodontitis (n = 22), periodontitis without DM (n = 16) and control (n = 19). All participants underwent physical examinations (BMI, WC, periodontal status examination) and laboratory examinations (FBG, fasting insulin, CRP, adiponektin, leptin, TNF-α and IL-10).ResultsThe proportion of severe periodontitis were higher in DM-periodontitis group compared to periodontitis without DM (77.3% vs 6.2%). DM-periodontitis group had lower adiponectin levels than that of periodontitis without DM group [5860.78 ± 4182.40 vs 9553.13 ± 6794.73; p = 0.046]. TNF-α/IL-10 ratio was significantly higher in the periodontitis without DM compared to control group [1.96 (1.68–2.32) vs 1.55 (1.27–1.85); p = 0.015].ConclusionLocal inflammation such as periodontitis, elevated systemic inflammatory markers (TNF-α/IL-10 ratio). Meanwhile chronic hyperglycemia alter adipocytokines level. The changes of systemic inflammation among diabetic group had not been shown yet in this study since some antidiabetic and antilipid drugs possess anti-inflammtory effect. Age, WC and FBG correlated with severe periodontitis. Adiponectin, leptin, TNF-α and IL-10 levels did not correlated with severe periodontitis.     

Captopril treatment in rheumatic heart disease with congestive heart failure. A preliminary report

A small scale controlled trial of captopril (ACE inhibitor) was conducted in 8 children with congestive heart failure due to rheumatic mitral regurgitation with or without mild mitral stenosis. The age of the patient ranged from 5.5 to 13 years (mean 9.3 years). Four children, served as control group, received digitalis and diuretics as standard treatment; while the other 4 children also received 2 x 12.5 mg of captopril in addition to standard treatment. The effect of both regimens were measured by using changes of left ventricular function as seen on the echocardiogram performed before treatment, and then 3, 7 and 14 days thereafter. Definite conclusion cannot be made because of the small number of patients; but it is apparent that some improvements of left ventricular functions in the captopril group were more evident when compared with that of the control group of standard treatment. Side effects of captopril were not found.     

Prevalence and Severity of Periodontitis in Indonesian Patients With Rheumatoid Arthritis

Background: Patients with rheumatoid arthritis (RA) may have more prevalent and severe periodontitis than healthy controls. Periodontitis may increase the systemic inflammation in RA. The aim of this study is to assess periodontitis prevalence and severity and its potential association with systemic inflammation in Indonesian patients with RA. Methods: A full‐mouth periodontal examination including probing depth, gingival recession, plaque index, and bleeding on probing was performed in 75 Indonesians with RA and 75 age‐, sex‐, and smoking‐matched Indonesian controls. A validated questionnaire was used to assess smoking, body mass index, education, and medical conditions. In addition, in all participants, the use of drugs was noted, and erythrocyte sedimentation rates and serum levels of high‐sensitivity C‐reactive protein (hsCRP), rheumatoid factor, and anti‐citrullinated protein antibodies were measured. Differences in periodontitis prevalence and 12 measures of periodontitis severity between patients with RA and controls were analyzed using univariate analyses. Results: No significant differences in periodontitis prevalence and 11 measures of periodontitis severity between patients with RA and controls were observed. Conversely, patients with RA had a significantly lower surface area of healthy pocket epithelium versus controls (P = 0.008), and a tendency toward higher hsCRP levels was observed in patients with RA with severe periodontitis compared with patients with RA with no mild or moderate periodontitis (P = 0.063). It has to be noted that all patients with RA were on anti‐inflammatory drugs, whereas none of the controls used such drugs. Conclusion: Prevalence and severity of periodontitis in Indonesian patients with RA is comparable to controls but with less healthy pocket epithelium than in controls and a tendency toward a higher inflammatory state in patients with RA and severe periodontitis.     

Expectant management of preterm preeclampsia in Indonesia and the role of steroids

Objective: To present the outcome of expectant management of preterm preeclampsia in Indonesia, and the effect of ongoing treatment with methylprednisolone (MP) on maternal and perinatal outcome.

Material and methods: Prospective RCT on 48 patients with early-onset preeclampsia. Following the administration of dexamethasone for fetal lung maturation, patients were randomized to receive 25?mg MP group IV for the first week, decreasing to 12.5?mg during 2nd week and continued till birth, or matching IV placebo treatment (PL group). Prolongation of entry to delivery interval served as primary outcome measurement.

Results: The average time gained with expectant management was almost 14 days. However, there was no difference of mean time interval between entry to delivery between the PL (13.8 days) and MP (13.7 days) groups. Antenatal ongoing treatment with IV MP also did not improve maternal and/or perinatal outcome and might be associated with a higher risk for severe maternal infections – in particular tuberculosis.

Conclusion: Expectant management of preterm preeclampsia is a realistic option in a major Indonesian perinatal referral center. Steroids (outside the use for fetal lung maturation) should not be used in the expectant management of preterm preeclampsia in Indonesia.