Risk factors for the development and progression of retinopathy of prematurity in preterm infants in Indonesia.

BACKGROUND: Risk factors other than supplemental oxygen might play a role in the development of retinopathy of prematurity (ROP). In Indonesia ROP occurs in infants up to 34 weeks and 2000 g. Risk factors for the development of ROP in Indonesian NICUs have not been evaluated. Our aim was to identify other risk factors than the use of oxygen in the development and progression of ROP in preterm infants in Indonesia. METHODOLOGY: Data on 98 preterm infants with ROP and 77 controls were collected from four NICUs and two eye centers in Jakarta, Indonesia, between 2009 and 2014. We used multivariate logistic regression analysis to determine the relationship between infants and environmental variables and the development and progression of ROP. We obtained variables for ROP severity by using Cox regression analysis. RESULTS: Factors associated with the development of ROP were birthweight (BWt), intrauterine growth retardation (IUGR), exchange transfusion, duration of oxygen supplementation, minimum saturation monitor setting, and socioeconomic factors. Regarding the progression, gestational age (GA), out-born, duration of supplemental oxygen, minimum saturation monitor setting, and socioeconomic factors were identified as risk factors. CONCLUSION: The use and control of supplemental oxygen are the main risk factors for the development and progression of ROP in preterms in Indonesia. Additionally, we confirm that GA, BWt, and IUGR are risk factors. Moreover, we found exchange transfusion to be a risk factor, and we found a lower rate of ROP in infants from a lower socioeconomic background. These risk factors apply to infants with a GA up to 34 weeks and a BWt up to 2000 g.

Preliminary findings on iron supplementation and learning achievement of rural Indonesian children.

The effects of oral iron supplementation on blood iron levels and learning achievement in 130 rural Indonesian school children were assessed in this double-blind study. The children were classified into anemic and nonanemic groups according to their initial hemoglobin and transferrin saturation levels and were randomly assigned to either iron or placebo treatment for 3 mo. Hematological, anthropometric, and learning-achievement data were collected before (T1) and after (T2) the treatment period and 3 mo later. The means and standard deviations suggest that supplementation with 10 mg ferrous sulfate per kilogram body weight per day for 3 mo resulted in an apparent improvement in anemic subjects' hematological status and learning-achievement scores. No tests of statistical comparisons are reported.

Iron supplementation and physical growth of rural Indonesian children.

The effect of oral iron supplementation on blood Fe levels and physical growth in 119 rural Indonesian school children was assessed in this double-blind study. The children were classified into anemic and normal groups according to their initial hemoglobin and transferrin saturation levels and were randomly assigned to either Fe or placebo treatment for 12 wk. Hematological, anthropometric, and morbidity data were collected before and after the treatment period. Before treatment, anemic subjects were smaller and had higher morbidity than normal subjects. Treatment with 10 mg ferrous sulfate.kg-1.d-1 for 12 wk resulted in a significant improvement in anemic subjects' hematological status, growth velocity, and level or morbidity.

Iron deficiency anemia and educational achievement.

The present study investigates the effect of iron supplementation on measures of school performance among 78 iron-deficient anemic and 41 nonanemic children in an economically deprived rural area in Central Java, Indonesia. All the subjects were treated for ancylostomiasis before iron supplementation. They were randomly assigned to either an iron or placebo group. Hematological and behavioral measurements were obtained immediately before (T1) and after (T2) the iron and placebo treatments. Iron treatment for a 3-mo period resulted in substantive increases in mean Hgb, Hct, and transferrin saturation among the iron-deficient anemic children. Furthermore, changes in the iron status of iron-deficient anemic children were associated with significant changes in the school achievement test scores of iron-deficient anemic children. T2 evaluation of achievement test scores indicated that the difference between iron-treated anemic and nonanemic children was still statistically significant. However, when T1 scores were entered as a covariate, iron-deficient anemic subjects treated with iron obtained significantly higher delta achievement scores. Findings from the present study indicate that iron supplementation among iron-deficient anemic children benefits learning processes as measured by the school achievement test scores.

Is clinical outcome of dengue-virus infections influenced by coagulation and fibrinolysis? A critical review of the evidence.

Despite efforts to elucidate the pathogenesis of dengue fever, the progression into severe disease remains poorly understood. In-vitro findings suggest that coagulopathy and disturbances in fibrinolysis have a pivotal role in the pathophysiology. If disturbances in these processes are predictive of clinical outcome in this disease, there could be important consequences for both diagnosis and treatment. We have critically reviewed publications on this topic to assess whether there is an association between activation of coagulation and fibrinolysis and clinical outcome of dengue-virus infections. In general, the selected studies showed activation of both the coagulation and fibrinolytic systems in this infection. The activation was more pronounced in severe infections and in cases with a poor clinical outcome. However, the findings were not consistent, and owing to a lack of detailed information on characteristics of patients, disease, and study design, we could not ascertain whether inconsistencies were caused by differences in these characteristics, selection bias, or confounding factors. We conclude that an association between activation of coagulation and fibrinolysis and clinical outcome of dengue-virus infections is conceivable but has been inadequately assessed and that methodologically sound studies, complemented with complete and reliable reporting, are needed to show whether there is a true association.

Seroprevalence of human T-lymphotropic virus type 1 in Papua New Guinea and Irian Jaya measured using different western blot criteria.

BACKGROUND: Endemic foci of HTLV-1 carriers have been found in the world, however, the origin of HTLV-1 in humans is still unclear. Since a distinct type of virus strain was isolated from the Solomon Islands, detailed surveys on HTLV-1 prevalence in New Guinea are important to shed light on its history of dissemination. OBJECTIVE: To clarify the seroprevalence of HTLV-1 in different regions of New Guinea Island. STUDY DESIGN: Sera from 1221 individuals (649 males, 454 females and 118 unknown) in New Guinea Island were studied for the presence of antibodies to HTLV-1 by a particle agglutination and the Western blot (WB) tests. Two different sets of criteria, proposed by WHO and Kiyokawa et al., were employed to interpret the WB test. Since the latter seemed to lack adequate specificity, the WHO criteria was used for the evaluation of the seroprevalence throughout the study. RESULTS: Seroprevalence of HTLV-1 differed by the WB criteria. By the more stringent criteria, HTLV-1 carriers were found in Madang, Chimbu and one hinterland province, Enga, in Papua New Guinea. An overall seroprevalence rate in different regions ranged from 0 to 14.6%. No seropositive individuals were found in Irian Jaya. CONCLUSIONS: To avoid overestimating the seropositivity rates, the WHO criteria would be more appropriate to employ for WB test by using the samples obtained from tropical and/or malaria endemic areas. This study is the first to show HTLV-1 infected individuals in the hinterland of New Guinea Island.

Daily and weekly iron supplementation and physical growth of school age Indonesian children.

OBJECTIVE: To investigate the effect of 3 months iron supplementation on physical growth among anemic school children given daily and weekly and to know the response based on hemoglobin level. SUBJECT: One hundred forty-four children were measured for height, weight and hemoglobin level. Ninety seven children were anemic (67.36%) with Hb level < 12 g/dl and forty seven children were non anemic. anemic children were divided into 2 subgroups and randomly assigned to either daily and weekly Fe treatment for 12 weeks. The non anemic group were treated with weekly iron supplementation, which was accepted by the parents. OUTCOME MEASURES: Children's height, weight, and hemoglobin of T1 and T2 food recall method was used to know calorie, protein, vitamin C and iron intake in both daily and weekly subgroups. Three days food recall was performed in the second and third months by a nutritionist. RESULT: After iron supplementation, the hemoglobin level in both group increased significantly. The average change of hemoglobin between the 2 groups gave no significant difference. W/A and H/A after iron supplementation showed significantly increased in both groups. The average change of W/A and H/A between the 2 groups gave no significant difference. CONCLUSION: Daily and weekly iron supplementation showed no significant difference in increasing of hemoglobin level and physical growth. Further research must be done with appropriate sample size and well design.

Cis-acting effect of the IL1B C-31T polymorphism on IL-1 beta mRNA expression.

Since the effect of IL1B polymorphisms on IL-1beta production is still controversial, we selected two polymorphisms to test their cis-acting effect on IL-1beta mRNA expression by means of the allele-specific transcript quantification and the haplotype analysis. As for the C-31T polymorphism, we found that expression of the -31T allele was 2.2 times of the -31C allele. This higher transcription efficiency may correspond to the fact that C-31T is located in a TATA box. The other polymorphism, C+3954T, did not alter the levels of transcription. The use of the allele-specific transcript quantification enables us to exclude trans-acting effects of polymorphisms on the gene expression and contributes to understanding the roles of the IL1B polymorphisms in susceptibility to multifactorial diseases.

Molecular variants of red cell glucose-6-phosphate dehydrogenase deficiency in Central Java, Indonesia.

One hundred and sixty-nine Javanese males were screened for the presence of red cell glucose-6-phosphate dehydrogenase (G6PD) variants by a dye decoloration screening test and starch gel electrophoresis. The frequency of G6PD deficiency was 14%. Three non-deficient electrophoretic variants with mobilities of 95, 105 and 107% of GdB+ were encountered. Sixteen G6PD-deficient subjects were further investigated for the presence of mutations at nt95 A-->G, nt487 G-->A, nt493 A-->G, nt563 C-->T, nt1024 C-->T, nt1376 G-->T, nt1388 G-->A and the silent mutation (nt1311 C-->T) of the G6PD gene by natural or artificially created amplified restriction sites. They were identified by the polymerase chain reaction and electrophoresis of restriction-digested products. Five subjects had the Mediterranean mutation (nt563 C-->T), but only one had simultaneous presence of nt1311(T). The next common mutations were 1376(T) in three subjects and 487(A) in two subjects. Five of the sixteen subjects had the nt1311(T) mutation giving an overall frequency of 0.31. The other four mutations were absent in this population sample.

Influence of polymorphisms for apolipoprotein B (ins/del, XbaI, EcoRI) and apolipoprotein E on serum lipids and apolipoproteins in a Javanese population.

A total of 231 healthy subjects from a central Javanese population were investigated for the distribution of three apolipoprotein B (apo B) polymorphisms (ins/del, XbaI, and EcoRI), as well as apolipoprotein E (apo E) polymorphism in relation to serum lipid and apolipoprotein concentrations. The frequencies of the rarer alleles (del, 0.09; X+, 0.1; and R-, 0.06) were lower than have been found for some Asian and European populations. Distribution of genotypes was in Hardy-Weinburg equilibrium for all the polymorphisms. A linkage disequilibrium was observed only between the ins/del and XbaI site polymorphisms of apo B (chi 2(4)) = 25.3; P < 0.001) consistent with that observed in some other population studies. No polymorphism of the apo B gene had an association with serum lipid or apolipoprotein concentrations in this population except for XbaI, which appeared to be associated with serum TG (as the log transform: R2 = 8.3; F = 4.8; P < 0.01). The apo E4 allele was found to be associated with significantly higher serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC). Apo E polymorphism explained 5.9% of the sample variance of serum LDLC (F = 5.4; P < 0.01).

Analysis of five Y-specific microsatellite loci in Asian and Pacific populations.

We have analyzed five Y-specific microsatellite loci (DYS388, DYS390, DYS391, DYS394, DYS395) in 17 Asian and Pacific populations representing a broad geographical area and different linguistic families, with an emphasis on populations from mainland and insular Southeast Asia. Analysis of gene diversity indicates that several of the studied populations have experienced substantial genetic isolation, and a reduction in male effective sizes (viz. the Northeast Indian populations Nishi, Adi and the Taiwanese aboriginals). The average values of the F(ST) and ((ST) statistics indicate a high degree of genetic differentiation among these populations at the five Y-specific markers (F(ST) =0.21 and ((ST) = 0.33, based on individual loci; F(ST) = 0.09 and ((ST) = 0.36, based on haplotypes), which conform to the expectation of a fourfold smaller effective size of the Y-linked loci compared with the autosomal loci. Dendrogram and principal coordinates analysis, with few exceptions, show a major separation between mainland and insular populations. Among the mainland populations, the Tibeto-Burman speakers from Northeast India cluster in a well-defined group, supported by high bootstrap values. The Southern Chinese, Northern Thai, So, and Cambodian also are integral to this cluster. The other major cluster is rather heterogeneous and includes, among others, the Austronesian-speaking populations. The Samoans of the Pacific, with a distinctive pattern of allelic distributions, stand as an outlier in the tree and PC representations. Although trends of genetic affinities among ethnically and geographically related populations are evident from the Y-specific microsatellite data, microsatellites are not optimal for deciphering complex migratory patterns of human populations, which could possibly be clarified by using additional and more stable genetic markers.

Genetic variation at 9 autosomal microsatellite loci in Asian and Pacific populations.

Genetic variation at 9 autosomal microsatellite loci (CFS1R, TH01, PLA2A, F13A1, CYP19, LPL, D20S481, D20S473, and D20S604) has been characterized in 16 Asian and Oceanic populations, mostly from mainland and insular Southeast Asia. The neighbor-joining tree and the principal coordinates analysis of the genetic relationships of these populations show a clear separation of Papua New Guinea Highlanders and, to a lesser extent, Malayan aborigines (Orang Asli or Semai) from the rest of the populations. Although the number of markers used in this study appears to be inadequate for clarifying the patterns of genetic relationships among the studied populations, in the principal coordinates analysis a geographic trend is observed in the mainland and insular Southeast Asian populations. Furthermore, in an attempt to contrast the extent of variation between autosomal and Y-chromosome-specific microsatellite loci and to reveal potential differences in the patterns of male and female migrations, we have also compared genetic variation at these 9 autosomal loci with variation observed at 5 Y-chromosome-specific microsatellites in a common set of 14 Asian populations.

Twenty-seven base pair deletion in erythrocyte band 3 protein gene responsible for Southeast Asian ovalocytosis is not common among Southeast Asians.

Screening for a 27-bp deletion in the band 3 protein gene that causes Southeast Asian/Melanesian ovalocytosis (SAO) was carried out using the PCR method among 15 Southeast Asian populations of Thailand (Akha, Hmong, Isaan, Red Karen, White Karen, Black Lahu, Lisu, Manni, Shan, and central Thais) and Indonesia (Bugis, Dayak, Javanese, Madurian, and Toraja). Individuals with the 27-bp deletion were identified only in the Bugis of southern Sulawesi, the Dayak of southern Borneo, and Javanese of central Java. The gene frequency of the 27-bp deletion in the general population was rather low: 0.012 and 0.013 in the Dayak and the Bugis, respectively. This restricted ethnic and geographic distribution of the 27-bp deletion suggests (1) local differentiation in the prevalence of this deletion in a given ethnic group and (2) the presence of molecular heterogeneity of SAO.

Sero- and molecular typing of Duffy blood group in Southeast Asians and Oceanians.

Duffy blood group was studied among malaria-endemic Thai and Indonesian populations: Hmong (n = 103), Akha (n = 218), Lisu (n = 44), Bugis (n = 95), Toraja (n = 77), Dani (n = 44), Mee (n = 80) and Irianese (n = 81). Phenotypes were studied by the ordinal indirect Coombs' test and genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) test. DNA analysis was used to type the Duffy blood group system. Deduced allele frequencies of Fya (0.958-1.0) based on the phenotypes were similar to those in other populations in Southeast Asia and Oceania. The study revealed the presence of Fya-antigens showing weak reactivity to antisera as well as a discrepancy between the genotype shown by the PCR-RFLP study and that predicted by the phenotype. The PCR-RFLP study also suggested the presence of an alternative genetic basis for the Fy(a- b-) phenotype, which differs from the African type.

Deletional types of alpha-thalassaemia in central Java.

The frequency of deletional alpha-thalassaemia in a Javanese population sample (n = 103) was investigated at three restriction sites of the alpha-globin gene (BamHI, BglII and RsaI). The overall gene frequency of alpha+ deletional thalassaemia was found to be very low (0.03). Leftward (-alpha 4.2) and rightward (-alpha 3.7) deletions and triplicated genes were present in equal frequency (0.015 and 0.005, respectively).