31 Jan 2023
31 Jan 2023
Mean platelet volume (MPV) had been linked to prognosis in many studies. It is widely available in daily clinical practice and has minimal economic burden. Previous adult study reported that the MPV to platelet count (MPV/platelet) ratio is superior to the MPV alone in predicting mortality in certain condition. To analyse the association between MPV/platelet ratio and mortality in critically ill children. A prospective cohort study was conducted on patients admitted to pediatric intensive care unit (PICU). Platelet indices were measured on the first and third day of PICU admission. Mortality during PICU admission were recorded. 80 subjects were recruited. MPV/platelet ratio on day 3 were statistically different between survivors and non-survivors group [ 3.8 (0.06-63.1) vs 7.5 (1.49-36.2), p = 0.037]. Increased MPV/platelet ratio on day 3 was associated with higher mortality (p=0.048), while increased MPV alone was not (p=0.693). Multivariate analysis showed that increased MPV/platelet ratio on day 3 (OR=5.8 (95% CI 1.25-27.30), p= 0.025) was one of independent predictor factors of mortality. Increased MPV/platelet ratio on day 3 was significantly associated with higher mortality. Clinical application of MPV/platelet ratio as prognostic predictor in critically ill children needs further study.
Serious ileus or intestinal obstructions are assumed from post-marketing records of incretin based-therapies including GLP-1a (namely exenatide and liraglutide), however this has not yet been confirmed. The use of an incretin-based drug has been shown to be associated with 4.5 times higher risk of intestinal obstructions compared to other anti-diabetes drugs. However, to our knowledge, there are no reported cases of gastric outlet obstruction with semaglutide. Here, we present a 29 – year– old male with type-1 diabetes who presented to the emergency unit with five days-history of nausea, vomiting, abdominal bloating, and constipation, starting one day after a single injection of semaglutide. On initial examination, the patient was afebrile, and normotensive. His body mass index was 29. Abdominal examination was remarkable for distension and tenderness to palpation on the epigastrium. The initial radiological assessment including erect abdominal x-ray, and pelvi-abdominal ultrasound revealed colonic gaseous distension. An Oral-enhanced abdominal CT-Scan revealed gastric dilatation with delayed gastric emptying suggestive of gastric outlet obstruction. As an initial management, naso-gastric tube was inserted at the emergency unit with suction of gastric fluids and infusion of intravenous fluids. The patient showed improvement after three days of conservative management with intravenous fluid resuscitation, antiemetics and proton pump inhibitors and was discharged from hospital. Two months later of withholding semaglutide, the patient was generally well with no recurrence of symptoms.
Stunting is defined as being below 2 standard deviations (SD) from the median height-for-age z-score (HAZ), as determined by the World Health Organization (WHO) Child Growth Standards. Several studies report that exclusive breastfeeding has protective effects againts stunting. Study concluded that children with low socioeconomic conditions can benefit from exclusive breastfeeding to reduce the incidence of stunting. However results of studies are contraty. The purpose of this study was to examine the association between exclusive breastfeeding and stunting in children. This systematic review research includes journals from the Google Scholar, Sciencedirect, and PubMed databases according to PRISMA which include the following requirements: last 5 years, abstract available, English language. The search terms used were “Breastfeeding” AND “Children” AND “Stunting” AND “Comparison”. From 270 articles found, 7 journals related were selected for further review. From this systematic review, it was shown that exclusive breastfeeding is associated with a reduction in the prevalence of stunting in children. But keep in mind that prolonged breastfeeding can cause impaired growth and development and compromised immune system. Education about the importance of exclusive breastfeeding is expected to reduce the incidence of stunting and short or long term related complications.
Covid-19 infection in pregnancy is thought to cause vertical transmission. SARS-CoV-2 can bind directly to the ACE-2 receptor of placental macrophages which results in infection of the placenta. CD68 is a protein that is highly expressed on the surface of cells derived from monocytes and macrophages, including placental macrophages. This study aimed to analyze CD68 expression in the placenta of pregnant women with Covid-19 as a marker of vertical transmission. This case-control study was conducted on 66 pregnant women consisting of 33 pregnant women with positive PCR results for Covid-19 and 33 pregnant women with negative Covid-19 at Dr. Moewardi General Hospital Surakarta, Central Java, Indonesia from May to November 2021. Placental CD68 expression was examined by immunohistochemical method. Data were analyzed using Mann-Whitney test, Two Way ANOVA test, and ROC. The mean placental CD68 expression of pregnant women with Covid-19 was higher than those without Covid-19 (17.52±16.23 and 9.25±5.08, respectively, with p=0.021). The mean placental CD68 expression in Covid-19 pregnant women with Covid-19 positive neonates was higher than those with Covid-19 negative neonates from both groups (34.83±34.02, 11.24±9.98, and 9.25±5.08, respectively, with p<0.001). ROC analysis showed that the cut-off of placental CD68 expression as a vertical transmission marker in pregnant women with Covid-19 was 19.8 with a sensitivity of 70.4% and a specificity of 73.1% (AUC=0.786). Placental CD68 expression of pregnant women with Covid-19 is a marker of vertical transmission.