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Background Children with Down syndrome (DS) differ from typical children because of many genetic-related aspects that may affect outcomes after congenital heart surgery. To date, there have been no studies on outcomes after congenital heart surgery on pediatric DS patients in Indonesia. Objective To determine outcomes and mortality in DS patients who underwent heart surgery at Dr. Cipto Mangunkusumo Hospital, Jakarta. Methods A prospective and retrospective cohort study was conducted in DS patients aged

Keywords : Abstract This research is aiming at identifying the urgency or importance of counseling guidance for prospective educators. The method applied in this research is mix-method by using two approaches based on instrument and technique of data collection, namely, interview and spreading questionnaire in the form of google form which filled by lecturers and students of Tarbiyah Faculty IAIN Sorong about the urgency of learning counseling guidance course at Tarbiyah Faculty IAIN Sorong. All study programs learn counseling guidance. The result of the research depicted that in implementing this point, the learning of counseling guidance becomes one of the much needed courses to the students of Tarbiyah Faculty IAIN Sorong with positive responses based on interview and it is supported by the result of questionnaire data processing were at 78,6 %. The implication is that there must be a strong synergy between the lecturers and students in the form of guidance services, in this case, the competent lecturer of counseling guidance should provide guidance and direction to students who need.

Tujuan penulisan ini adalah untuk mengctahui sejauh mana pengaruh metode hypnoteaching terhadap pembe lajaran pendidikan agama Islam bagi peserta didik MA. As- Syafi’iyah Hamzanwandi Angkona, Kabupaten Luwu Timur. Jenis penelitian ini adalah penelitian kuantitatif dengan desain eksperimen. Adapun pendekatan dalam penelitian ini yaitu pendekatan pedagogis, yaitu pendekatan yang digunakan untuk mengamati obyek penelitian dari aspek proses pendidikan khususnya tentang pengaruh penggunaan metode hypnoteaching dalam pembelajaran pendidikan agama Islam bagi peserta didik MA. As-Syafi’iyah Hamzanwandi Angkona,Kabupaten Luwu. Pendekatan psikologis, yaitu pendekatan yang digunakan untuk mengungkapkan nilai psikis dari obyek penelitian terutama tentang motivasi maupun kesulitan yang dirasakan peserta didik dalam pembelajaran pendidikan agama Islam. Pendekatan teologis, yaitu pendekatan yang digunakan untuk menilai dari segi pemahaman keagamaan, perilaku dan perbuatan peserta didik berdasarkan nilai-nilai ajaran Islam. Desain eksperimen ini menggunakan one group pretes-posttest. Sampel penelitian ini diambil dengan teknik sampel random sampling dari kelas XII sebanyak 20 responden. Pengelolaan dan analisis data dengan membandingkan hasil ulangan harian pra perlakuan dengan perlakuan I, perlakuan II, dan perlakuan III serta perbandingan lembar observasi yang berisi penilaian aspek kognitif, afektif, dan psikomotorik. Hasil penelitian ini menunjukkan bahwa pembelajaran dengan penggunaan metode hypnoteaching mampu memberikan pengaruh positif baik dari hasil belajar, maupun psikologi belajar yang terdiri dari ranah kognitif, afektif dan psikomotor. Penilaian diamati dari aspek pemahaman mengalami peningkatan dari perlakuan (P) PI berjumlah 5 orang, P II 9 orang, P III 13 orang. Aspek penghayatan P I berjumlah 13 orang, P II 15 orang, dan P III 17 orang. Sikap peserta didik yang tercermin dari akhlaknya meningkat dari P I sebesar 17 orang, P II 18 orang, dan P III 19 orang. Peningkatan hasil belajar peserta didik terbukti dari rata-rata nilai ulangan harian dari pra perlakuan sebesar 6,2%, perlakuan I sebesar 69, 5%, perlakuan II sebesar 75, 8%, dan perlakuan III sebesar 82%. Implikasi dari hasil penelitian ini bahwa penggunaan metode hypnoteaching dalam pembelajaran pendidikan agama Islam memberikan pegaruh positif bagi peserta didik. Temuan ini bisa dijadikan acuan bagi para pendidik untuk menerapkan metode hypnoteaching dalam pembelajaran. Disamping itu pengkajian psikologi dengan eksplorasi alam bawah sadar dapat meningkatkan peran pendidik sebagai tenaga mengajar yang profesional. Kata Kunci: Metode Hypnoteaching, Pendidikan agama Islam

Background: The alternative device to close perimembranous ventricular septal defect (pmVSD) has been searched for better result, less complications and applicable for infants. However, the ideal device is still unavailable. We aimed to evaluate the effectiveness and outcome of transcatheter pmVSD closure using the KONAR-multi functional occluder (MFO). Methods: Clinical, procedural, follow-up data of pmVSD patients with symptom of heart failure or evidence of significant left to right shunt, growth failure, recurrent respiratory tract infection, and history of endocarditis who underwent transcatheter closure using the MFO were prospectively evaluated. Results: Between January 2016 and December 2017, there were complete records of 132 pmVSD children closed using MFO from eleven centers in Indonesia. The median of age was 4.5 (0.3–17.4) years; weight 14.8 (3.5–57) kg, defect size at the smallest part 3.4 (1.0–8.1) mm, flow ratio 1.6 (1.3–4.9), mean pulmonary artery pressure 18 (7–79) mmHg, fluoroscopy time 18 (3.8–91) and procedural time 75 (26–290) minutes. A retrograde approach was done in 41 (31%) patients. Procedures succeeded in first attempt in 126 (95.4%), failed in three and migration in three patients. Six of eight infants with congestive heart failure were closed successfully. Of 126 patients with successful VSD closure, 12 months follow-up were completed in all patients. The rate of complete occlusion at 1 month, 3 months, 6 months and 12 months after intervention were 95.2%, 97.6%, 99.2%, and 99.2%, respectively. New-onset aortic regurgitation and moderate tricuspid regurgitation developed only in five and three patients. Neither complete atrioventricular block, nor other complications occurred. Conclusion: Transcatheter closure of pmVSD using the MFO is safe, effective, and feasible in infants and children.

This article explores the trends in the implementation of Islamic moderation through aqidah and sharia in Singkawang, as it is considered the most tolerant city in Indonesia based on a research report published in 2019. Using grounded research analysis, the authors found three structured patterns: implementation strategies (as related to vision, mission, position, programme and impact), implementation processes (as related to main actors, levels of success and obstacles) and implementation patterns. This study shows that these strategies and methods, implemented through a flexible, straightforward and easy-to-implement model are relevant to the fundamental values of Islamic education and offer a means of forming a complete and comprehensive network. These implementation patterns encourage religious communities to develop and maintain healthy social relationships. Hopefully, such implementation patterns can be imitated and modified by policyholders to realise Islam rahmatanlil ‘alamin [as a blessing for all]. Contribution: Scholars in the fields may benefit from the findings of the research as it provides a new perspective of the Islamic educational moderation theory grounded from the field research. It argues that the practice of community tolerance, especially by the Muslims, has been based on the good understanding of the theology of Islamic education moderation. Education matters in the process of community peace building and in generating tolerance through the implementation of Islamic moderation values.

Balloon atrial sept ostomy is usually necessary for survival beyond infancy in patients with transposition of the great arteries and insufficient intracardiac mixing. Since the umbilical vein and ductus venosus are often patent in the newborn infants, this route can be considered as an alternative to a femoral venous route in a critically ill infant. A 7 day-old newborn with D-transposition with intact ventricular septum and small patent foramen ovate was successfully managed by creating atrial septal defect through transumbilical balloon arterial septostomy. The procedure was carried out in the neonatal intensive care unit, guided by 2D-echocardiography. The arterial oxygen saturation increased dramatically upon the completion of the procedure, and a large atrial septal defect could be demonstrated echocardiographically. Unfortunately the infant died before further definitive surgery was performed.

ICAM-1 release during sepsis is perceived to be related to brain injury. Whereas S100β has been known as one of brain injury markers.To measure mean value of ICAM-1, S100β, to find correlation between ICAM-1 and Glasgow Coma Scale (GCS), between S100β and GCS, also ICAM-1 and S100β.Analytical cross sectional study in 34 sepsis children, measurement of ICAM-1 and S100β plasma levels within day 1 and 3 since diagnosis of sepsis.Median level of ICAM-1 day one 548,1 (158,6 – 1256,1) ng/mL and day three 596,5 (185,5 – 1264,5) ng/mL (p=0,164). S100β median is significantly higher in severe than mild sepsis (p=0,008 dan p=0,021). On third day S100β was negatively related to GCS (r= - 0,452; p=0,003). The correlation observed between ICAM-1 and S100β on day one was r=0,146 (p=0,409) while on third day was r=0,184 (p=0,298).The prevalence of encephalopathy sepsis is 5.9%, Median ICAM-1 is higher on day three. Median of S100β is higher in severe than mild sepsis.There is no correlation between ICAM-1 and GCS in both sepsis. There was negative correlation between S100β and GCS on 3rd day of sepsis. No correlation between ICAM-1 and S100β on both measurement days.

Background: Evaluating outcome and identifying predictors of major complications among children undergoing cardiac surgery are essential to improve care. We evaluated short-term outcomes of postcardiac surgery and predictors of major complications in a national referral hospital in Indonesia. Methods: A prospective cohort study was conducted from April 2014 to March 2015 on all children undergoing cardiac surgery. Participants were followed up from the time of surgery until hospital discharge and 30-day mortality. We performed univariate and multivariate logistic regression using STATA 12-1 to identify predictors of postsurgical major complications. Results: A total of 257 patients (median age: 36 months) were recruited; 217 (84.1%) had complications, including low cardiac output syndrome (19.8%), arrhythmia (18.6%), sepsis (17.4%), and pleural effusion (14.8%). Forty-nine (19%) patients had major complications, including cardiac arrest (5%), need for emergency chest opening (3.9%), and multiple organ failure (7.4%). 12.8% died during hospital stay, and 30-day mortality was 13.6%. Predictors of major complications were cyanotic congenital heart disease (odds ratio [OR]: 4.6, 95% confidence interval [CI]: 1.5–14.2), longer duration of cardiopulmonary bypass (CPB, OR: 4.4, 95% CI: 1.5–13.4), high inotropes (OR: 13.1, 95% CI: 3.2–54.2), and increase in lactate >0.75 mmol/L/h or more in the first 24 h (OR: 37.1, 95% CI: 10.1–136.3). Conclusion: One-fifth of children undergoing cardiac surgery experienced major complications with around 13% mortality. Cyanotic congenital heart disease, longer duration of CPB, high inotropes on leaving operating theater, and increase in blood lactate are associated with major complications in children after cardiac surgery.

We report a case o fhereditary long Q-T syndrome without congenital deafness (Romano-Ward syndrome). In four members of a family, a father and his daughters, the Q-T intervals on the EKG were found to be prolonged. There were no other accompanying familial anomalies such as deafness or a tendency to extracellular hypokalemia The youngest daughter which had the longest. Q-T interval had several Adams-Stokes attacks, and died in the last attack at the age of 23 months. Her two older siblings died at the age of 15 and 10 months with the same typical clinical histories. The eldest daughter, a 12-year old girl, has no clinical symptoms at all, while the fourth child, 5-yeltr old girl has several occasions of near fainting attacks. The EKG of the father showed several runs of supraventricular premature contractions that ceased spontaneously, besides evidence of the prolongation of Q-T interval. The beta-adrenergic blocking drug (propranalol) given in a relatively small maintenance dose, proved to be effective in preventing attacks of the father and the fourth child, despite the unchanged prolongation of the Q-T interval.

We evaluated the implementation of diagnostic criteria on 547 ambulatory patients with rheumatic fever (RF) and rheumatic heart disease (RHD) between January 1, 1983 and December 31, 1992. The diagnosis of RF and reactive RHD was established by either revised Jones criteria, modified Jones criteria, or clinical judgment The patient's age ranged from 4-18 years, 255 (46.6%) of them were boys. The clinical manifestations found were fever (58.1 %), arthritis (41.9%), chorea (8.6%), subcutaneous nodule (1.3%), erythema marginatum (1.1%), holosystolic murmur (56.9%), mid-diastolic murmur (25.4%), and early diastolic murmur (29.5%). The laboratory changes were hemoglobin 20 mm/h (56.30/o), ASTO >200 U (29.6%), PR interval> 0.16 sec (13.3%), and erR> 0.55 (27.6%). Revised Jones criteria were met in 162 cases (29%), modified criteria in 474 cases (86,6%), and clinical judgment in 521 cases (95.2%).

We compared the diagnostic accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in 119 randomly selected from 400 patients with thalassemia major treated at the Department of Child Health, Medical School, University of Indonesia, Jakarta. Echocardiographically derived left ventricular hypertrophy (EchoLVH), both for body surface area (BSA)-indexed and height-indexed, served as the gold standard. There were 57 girls and 62 boys available, ranging in age from 5 to 27 years. ECG criteria for LVH was detected in 23 outof119 patients, while echo-LVH was detected in 47 patients if BSA-indexed LVH was used, or 22 patients if height-indexed LVH was used. The sensitivity and specificity of ECG-LVH were 25.5 and 84.7% respectively if BSA indexed LVH was used as gold standard, or 36.4% and 84.5%, respectively, when height indexed echo-LVH was used. It is concluded that ECG criteria for LVH has a low sensitivity and hjgh specificity in detecting increased left ventricular mass in children with thalassemia major.

Background Respiratory problems, such as aspiration pneumonia, are major causes of morbidity and mortality in children with cerebral palsy (CP) and greatly affect the quality of life of these children. Nevertheless, there is limited data on the incidence and risk factors of aspiration pneumonia in children with CP in Indonesia. Objective To determine the incidence and risk factors of aspiration pneumonia in children with cerebral palsy. Methods In children with CP aged 1-18 years, incidence of pneumonia was studied prospectively for 6 months and the prevalence of the risk factors was studied cross-sectionally. At baseline, we evaluated subjects’ by history-taking, physical examination, risk factors, and chest X-ray to assess the incidence of silent aspiration. Subjects were followed-up for six months to determine the incidence of overt or silent aspiration pneumonia. Results Eight out of 36 subjects had one or more episodes of aspiration, consisting of silent aspiration (2/36) and clinically diagnosed aspiration pneumonia (7/36). Subjects with more severe gross motor dysfunction experienced more episodes aspiration pneumonia, although it was not statistically significant (p = 0.06), while dysphagia (P=0.2) and nutritional status (P=0.11) were not associated with pneumonia or silent aspiration. Conclusion Twenty-five percent of children with CP experienced aspiration pneumonia during the 6-month study period, with gross motor dysfunction as a possible risk factor.

Background Indomethacin and ibuprofen are the drugs of choice for closure of patent ductus arteriosus (PDA) in preterm infants. However, intravenous preparations are of limited availability in Indonesia. Circumstantial evidence has shown that intravenous paracetamol may be an alternative therapy for PDA closure in premature infants. Objective To evaluate the effect of intravenous paracetamol on PDA closure in preterm infants. Methods A before-and-after study was conducted between May and August 2014 in Cipto Mangunkusumo General Hospital, Jakarta in preterm infants with hemodynamically significant PDAs, as established by echocardiography using the following criteria: duct diameter >1.4 mm/kg, left atrium to aorta ratio >1.4, and mean velocity in the left pulmonary artery >0.42 m/s or mean diastolic velocity in the left pulmonary artery >0.2 m/s. Subjects, aged 2 and 7 days, received intravenous paracetamol (15 mg/kg every six hours) for 3 days. Paired T-test was used to compare pre-intervention PDA diameter to those assessed at 24 hours after the intervention and at 14 days of life. Results Twenty-nine subjects had a mean gestational age of 30.8 weeks and mean birth weight of 1,347 grams. Nineteen (65.5%) patients had closed PDAs at the day 14 evaluation, 1 experienced PDA reopening, and 9 had failed PDA closure. No liver toxicity was identified. Mean duct diameters before, 24 hours after the intervention, and at 14 days of life were 3.0, 0.9, and 0.6 mm, respectively (P

During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety.

Latar belakang. Penyakit jantung reumatik merupakan kelainan jantung didapat penyebab kesakitan dan kematian terbanyak pada anak di Indonesia. Bedah katup pada anak dengan penyakit jantung reumatik jarang dilakukan. Tujuan. Untuk mengetahui profil klinis dan keluaran bedah katup pada anak dengan penyakit jantung reumatik. Metode. Penelitian secara retrospektif dilakukan pada 28 anak dengan penyakit jantung reumatik yang menjalani bedah katup di RSUPN Cipto Mangunkusumo selama tahun 2003 sampai 2009. Data dikumpulkan dan dicatat berdasarkan catatan medis berupa profil klinis sebelum operasi, umur saat operasi, jenis kelamin, status klinis, dan jenis operasi, serta data ekokardiografi berupa kelainan katup dan fungsi ventrikel. Sedangkan keluaran berupa komplikasi pascaoperasi, lesi residual dan fraksi ejeksi, fraksi pemendekan serta dimensi akhir diastolik ventrikel kiri seminggu pascaoperasi. Hasil. Umur rerata saat operasi 13,9 (SD 2,7) tahun; anak laki-laki dan perempuan sama banyak. Status klinis praoperatif fungsional kelas III dan kelas IV masing-masing terjadi pada 13 dan 9 anak. Regurgitasi mitral berat didapatkan pada 75% anak. Perbaikan katup mitral dilakukan pada 16, penggantian katup mitral pada 8, dan penggunaan katup ganda pada 4 anak. Tiga anak mengalami komplikasi berupa perdarahan, efusi pleura, dan sepsis, sedangkan satu orang meninggal. Lesi residual pascaoperasi didapatkan pada 11 anak, berupa regurgitasi dan stenosis mitral ringan, dan satu anak dengan paravalvular leak. Tidak didapatkan perbedaan yang bermakna dalam fraksi ejeksi, fraksi pemendekan dan dimensi akhir diastolik ventrikel kiri sebelum dan seminggu sesudah operasi. Kesimpulan. Bedah katup pada anak dengan penyakit jantung reumatik mempunyai keluaran yang baik, dengan angka kematian dan komplikasi yang rendah. Pemantauan lebih lanjut diperlukan untuk menilai keluaran jangka panjang.