Pediatria Medica e Chirurgica最新文献

Hospitalized children receive anxiety-triggering medical procedures, such as inhalation therapy. One non-pharmacological intervention that can be provided to reduce children's anxiety is pop-it therapeutic play. This study aimed to measure the effectiveness of pop-it therapeutic play on children's levels of anxiety during inhalation therapy in children's wards. This study used a randomized control trial involving 66 children aged 1-12 years who received inhalation therapy and were treated in the children's ward from three hospitals in North Sulawesi. The respondents were divided into intervention and control groups, with 33 respondents for each group. The samples were selected using simple random sampling. Anxiety level was assessed using the Visual Facial Anxiety Scale. The findings showed that playing pop-it effectively reduced children's anxiety levels during inhalation therapy, with a p value of 0.000 (α < 0.05). Therefore, playing pop-it is the right solution for children who receive inhalation therapy and is recommended as an alternative toy in hospitals. This finding can be applied in children who receive inhalation therapy because it is easy to do, efficient and effective controlling the children's anxiety.

This study compared the scale of infant pain during vaccinated injection using conductance skin electric (Skin Conductance), the Wong-Baker Faces Scale (WBFS) instrument, and Face Leg Activity Cry and Consolability (FLACC) instruments. It was observational cohort study with pre-experimental design using vaccinated injection as pain stimuli. This study investigated 121 infants (59 boys, 62 girls), age/PNA 4.37 ± 2.97 months, and current body weight 6522 ± 1378.65 grams). Most infants had adequate birth weight 71 (89.9%) about 2985.74 ± 405.83 kg and mature infants as 67 (84.4%), about 38,52 ± 2,09 weeks. Pain measurement of all three instruments was do simultaneously using a developed Skin Conductance (SC) apparatus and video recording (to assess behaviour and face). WBFS, FLACC and SC have the same significance in measuring infants' pain scale during vaccination injection. Statistical analysis showed a significant difference in the three pain measurement instruments between before and during injection with a p value of <0.001. So that SC can be recommended for pain measurement.

Adolescents are at risk in experiencing mental health problems if the risk factors owned are more than the protective factors. This study aims to identify the effectiveness of Mental Health nursing promotive and preventive models on protective factors, risk factors and Adolescents' Mental Health. This research was with quasi-experiment, design employed randomization control group pre and post-test design conducted on 240 adolescents, which was divided into both groups equally. The study found that protective factors (self-esteem, family relationship, and prosocial ability) has increased after intervention model by 10.2%; 4.4%; 15.7%, respectively, risk factors (bullying behavior, anxiety, emotional problems, behavioral problems, and peer problems) has decreased after the intervention model by 9.8%; 26.1%; 25.9%; 17.5%; 22.4%, respectively. The model also increased the adolescents' mental health after intervention model by 14.9%. The mental health nursing promotive and preventive model is effective to increase the mental health of adolescents by 21.3%. Mental health nursing' promotive and preventive model could be used as basic needs to implement early detection regarding mental health of adolescents in the UKS scope and involving teachers' role, as well as parents in maintaining mental health.

The treatment given to children who have been confirmed positive for COVID-19 and are showing symptoms involves isolation, which consequently is an unpleasant experience for pediatric patients. In isolation rooms, children reported a "rollercoaster" of feelings due to being separated from their families and familiar surroundings. This study examines children's emotions while being hospitalized in isolation rooms due to COVID-19. The study follows a descriptive qualitative design. Online interviews were carried out and involved 10 children who had been confirmed positive for COVID-19 and were hospitalized in two big cities in Sumatra. Four themes emerged from the data: i) children's emotional conditions after finding out they had positive COVID-19 test results; ii) boredom and inconvenience during isolation; iii) support from the children's peer; and iv) happy responses to receiving negative swab results and being allowed to go home. These themes describe the children's adaptation process to isolation based on the feelings they expressed during the interviews. This study suggests that, in order to improve their facilities, hospitals should support children's activities during isolation and nurses should improve their therapeutic communication with pediatric patients.

Malnutrition is among the most common nutritional problems in children worldwide. Specifically, stunting as a malnutrition problem is a global priority, including in Indonesia. This study analyses the effect of nutrition education interventions on maternal feeding knowledge, maternal feeding attitudes and children's weight. A quasi-experimental design using a pre-and post-test was selected and with a total sample of 70 people were assigned to an experimental and control group. This study was conducted in Jember Regency on July 2022, and the instrument used in this research were knowledge, attitude, and practice (KAP) questionnaires from the Food and Agriculture Organization (FAO). A Bivariate analysis showed that the nutritional education intervention had a significant relationship with increased maternal feeding knowledge and attitude and children's weight in the control group and intervention group (p-value <0.05). However, a higher score was on the intervention group score compared to the control group. Meanwhile, the average weight of the children in the intervention group increased by about 331.42 grams, which higher compare to the control group's average weight gain. This study concluded that health education about eating, according to the World Health Organization (WHO) recommendations, through an action-oriented group approach can significantly increase maternal feeding knowledge, attitudes, and children's weight.

Management of pediatric Primary Spontaneous Pneumothorax (PSP) is controversial and based on guidelines on adults. Therapeutic strategies include: observation, needle aspiration, chest drain, or surgery. We aimed to assess: i) differences in the management of PSP in pediatric vs. adult departments; ii) risk of recurrence associated to each therapeutic choice; iii) management of "large" pneumothorax (i.e. >3cm at the apex on chest X-Ray); iv) role of CT scan in addressing the treatment. We reviewed all PSP treated at Pediatric Surgery Unit (PSU) and Thoracic Surgery Unit for adults (TSU) in a 10-year period (2011 to 2020). We included a total of 42 PSP: 30/42 1st episodes and 12/42 recurrences. Among the 30/42 1st episodes, 15/30 were managed in the PSU and 15/30 in the TSU. Observation was significantly most common among PSU patients (9/15, 60%) vs. TSU cases (1/15, 6.7%; p=0.005]. Chest drain placement was reduced in PSU (3/15, 20%) vs. TSU (12/15, 80%; p=0.002). Observational was associated with a reduced risk of recurrence (0/10, 0%) compared to chest drain (7/15, 46.7%; p=0.01). Management of 20/42 "large" pneumothorax was: 4/20 (20%) observation, 10/20 (50%) chest drain, 2/20 (10%) needle aspiration, 4/20 (20%) surgery. Twentythree/ 29 PSP (79.3%) underwent CT-scan after the first episode. Bullae were detected in 17/23 patients and 5/17 (29.4%) had seven episodes of recurrence. PSP patients treated by PSU were more likely to receive clinical observation. Those managed by TSU were mostly treated by chest drain. Observation seems an effective choice for clinically stable PSP, with low risk of recurrence at a mid-term follow-up. CT-scan seems not to detect those patients at higher risk of recurrence.

Autoimmune Thyroid Disease (AIT) is a frequent comorbidity in Down Syndrome (DS). Protein Tyrosine Phosphatase Non- Receptor Type 22 C1858T (PTPN-22 C1858T) gene polymorphisms have a role in the progression of AIT. The study on PTPN- 22 C1858T gene polymorphism as the risk factor of AIT in DS children is still limited. This study aims to evaluate PTPN-22 C1858T polymorphism in Indonesian DS children. A cross-sectional study involving 31 DS children with hypothyroidism (19 boys/12 girls) was conducted for ten months from February to November 2020 at Dr. Soetomo General Hospital Surabaya. The PTPN-22 C1858T gene polymorphism was analyzed using Polymerase Chain Reaction-Restriction-Fragment-Length Polymorphism (PCR-RFLP). Anti-Thyroid Peroxidase (Anti- TPO) and Anti-Thyroglobulin (Anti-TG), FT4, T3, and TSH levels were analyzed using Enzyme-Linked-Immunosorbent-Assay (ELISA). The mean age of the subjects was 19.45±17.3 months. The CT variant of PTPN-22 C1858T was observed in all subjects. The mean level of T3, FT4, and TSH were 1.59±0.45 ng/mL, 0.81±0.57 ng/mL, 0.22±0.21 μU/mL, respectively. Around 83.9% of patients suffered from central hypothyroidism, 12.9% from primary hypothyroidism, and 3.2% from subclinical hypothyroidism. The positive anti-TG and anti-TPO were observed in 96.8% and 58.1%, respectively. CT variant was observed in Indonesian DS children who suffered from hypothyroidism.

Vascular (VH) according to Hellstrom-Chapman technique is considered a safe and effective alternative approach to pure extrinsic Ureteropelvic Junction Obstruction (UPJO) with good results in short and medium term, but few data are available on long and verylong term outcomes. Our aim is to evaluate VH long and very-long term outcomes in patients treated in pediatric age focusing on relapse, development of hypertension and/or inferior polar kidney hypotrophy during puberty and adulthood. From 1990 to 2015 in our Department 76 children were treated by open or laparoscopic VH for pure extrinsic-UPJO. We were able to contact 54 of 76. 41 patients (25 males, 16 females) accepted to be studied. Mean follow- up time was 12.7 years (range 6-27 years); mean age at the assessment was 22.2 years. We excluded patients who were younger than 13 (if females) or 14 (if males) at the assessment (upper limits of physiological puberty onset). Patients were followed with US, MAG-3-scan and arterial blood pressure measurement. Collected data were compared with the preoperative ones by Student t-test. 95% of US images and MAG-3-scan reports were compatible with complete resolution of obstruction with good renal functionality. 87% of patients were completely healthy. We recorded 3 cases of hypertension (7%) not secondary to renovascular origin; 2 cases with recurrent flank pain (5%) with slightly dilated pelvis at the US and sub-obstructive pattern at MAG-3-scan with preserved renal function. Our experience confirms that VH, (open/laparoscopic) is a safe and effective procedure with good outcomes at very longterm follow-up. No patients at puberty and in adulthood required reoperation or presented polar hypotrophy and related vascular hypertension. VH is an alternative approach to pure extrinsic-UPJO. There were few data about long and very-long term outcomes in patients after this kind of surgery. We followed-up 41 patients confirming that VH (open/laparoscopic) is safe and effective with good long-term outcomes.

Nowadays laparoscopic Nissen fundoplication represents the gold standard in surgical treatment of complicated Gastro-Esophageal-Reflux Disease (GERD), above all in cerebral palsy patients. In non-neurological patients without gastrostomy Nissen fundoplication can create some problems (gas bloat syndrome, dysphagia). Laparoscopic Hill-Snow repair is an established surgical alternative, but it is reported only in adult population. We describe our modification of Hill-Snow technique and our experience in a large series of non-neurological children in order to report its effectiveness and applicability in pediatric patients affected by complicated GERD. Between 2000 and 2022, 319 children underwent surgical correction of gastro-esophageal reflux at our Department. All were affected by complicated gastro-esophageal reflux unresponsive to PPI (Proton Pump Inhibitors). 251 underwent laparoscopic Nissen fundoplication; 68 non-neurological patients underwent laparoscopic Hill-Snow repair. Of these 68 children 48 were males (71%) and 20 females (29%); median age was 5years (3 months-11 years). Weight range was 4-37kg. 52 patients (76.5%) presented the following symptoms: retrosternal pain, dysphagia, regurgitation, coughing, failure to thrive, persisting reflux esophagitis. 16 (23.5%) had chronic respiratory problems (aspiration, apneic-spells, dysphagia, coughing, choking, gagging). For 8 (11.8%) symptoms were expression of chronic recurrent gastric volvulus. All underwent modified-laparoscopic-Hill-Snow repair. Contrast study showed sliding hiatal hernia in 55 patients (81%), while endoscopy demonstrated 16 cases of histologically severe esophagitis (23.5%) and 52 of mild esophagitis (76.5%). No intraoperative/postoperative complications were recorded. 60patients had a complete follow-up (range 1-20 years). 60/68 patients were evaluated with barium-swallow-study at 6-12 months; 40/68 patients with upper-gastrointestinal-endoscopy at 12months. No relapse was reported. 50 patients (73.7%) were symptom-free. 18 (26.3%) referred occasional epigastric pain, associated with vomit in 2 cases. 64 (94.1%) referred ability to vomit; 4 temporary difficulty to swallow (average 30 days). All patients reported being able to burp. 3(4.5%) presented episodes of gas-air-bloat during the first 2 months with spontaneous resolution. No case of dumping syndrome was recorded. This technique's modification yields excellent results in term of relapse and side effects at long-term follow-up. We reported the first and largest pediatric series in non-neurological children with encouraging results.

A relatively new surgical procedure called Anterior Vertebral Body Tethering (AVBT) is used to treat scoliosis in patients with immature skeletons. It is a growth modulation fusionless system that Crowford and Lenke first described in 2010. We present our observations from 25 patients. Improvement in the mean coronal Cobb angle, from mean 57° preoperative to mean 34° postoperative, was 40%. Additionally, we noted that the mean thoracic hypokyphosis improved from 16° to 24° on average after surgery. Complication rates were 16% and surgical revision rates were 12%. All patients who demonstrated improvement in pain, function, and self-image underwent administration of the SRS-24 questionnaire. These data, according to the literature, show that AVBT is a reliable technique that enables scoliosis correction in skeletally immature patients and maintains that correction while utilizing remaining growth potential to achieve further correction, avoiding spinal fusion, and maintaining spine mobility.