Articles

Puff of Smoke’ In A Young Brain: A Classic Imaging Sign of Moyamoya Disease – Case Report

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Moyamoya disease is a rare and progressive cerebrovascular disorder marked by the occlusion or blockage of the distal internal carotid arteries and their main branches. In response, the brain develops a network of fragile collateral vessels, which appear as a “puff of smoke” on angiographic imaging—a characteristic feature that inspired the disease’s name. The condition primarily affects children and young adults, often presenting with transient ischemic attacks, strokes, seizures, or cerebral haemorrhage. Although the underlying mechanisms are not fully understood, genetic factors, particularly mutations in the RNF213 gene, have been closely associated with disease susceptibility, The major susceptibility gene for moyamoya disease in people investigation into the mechanisms of disease and potential treatment targets. The Arg4810Lys variant of the gene is most strongly associated with moyamoya disease, but the penetrance is lower than 1%, suggesting a synergistic relationship with additional environmental and genetic risk factors. A 11-year-old female patient presented with the complaints of sudden onset of left upper limb and lower limb transient weakness associated with bowel incontinence patient has  a past medical history of seizures since 10 months with multiple seizure episodes Diagnostic evaluation typically involves magnetic resonance imaging, magnetic resonance angiography, and digital subtraction angiography, the latter of which remains the gold standard. Treatment strategies are primarily surgical, with revascularization procedures—either direct, indirect, or combined approaches—aimed at improving cerebral blood flow and reducing the risk of ischemic events . Based on laboratory investigations and radiological reports case was diagnosed as MOYAMOYA DISEASE preoperative and anaesthesia clearance patient was taken up for STA-MCA bypass (Superficial Temporal Artery to Middle Cerebral Artery Bypass) associated  treatment with perivascular sympathectomy and superior cervical ganglionectomy may be useful but more investigation needs to be carried out into the pathogenesis of the disease before more definitive therapy is realized.

This review outlines the latest developments in the understanding, diagnosis, and management of Moyamoya disease, with attention to its genetic background and surgical outcomes.

Obesity and Cholinesterase Level Related to Impaired Fasting Glucose in Indonesian Farmers

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Obesity is characterized by the excessive accumulation of fat caused by mutations in the leptin gene and its receptors. In Indonesia, the incidence of childhood obesity increased from 6.4% in 2007 to 9.2% in 2010. The prevalence and risk factors for childhood obesity in rural Indonesia, particularly in Teluk Pandan Subdistrict, Pesawaran District, Lampung Province, have not been extensively studied. This study aims to determine the prevalence and risk factors for childhood obesity in this rural-coastal area. A survey method was used for the prevalence study, and a case-control approach was used to identify risk factors. The study involved 94 students from elementary schools in Teluk Pandan, matched based on obesity status, gender, and age. Obesity was defined as a BMI at or above the 95th percentile of the CDC chart. Variables measured included dietary patterns, lack of physical activity, family income, parental obesity status, early introduction of complementary foods, and history of exclusive breastfeeding, analyzed using chi-square tests. The results showed that 148 out of 3190 children were overweight. Identified risk factors included excessive food consumption (p=0.0001; OR=15.622; CI95% 5.702-42.803), lack of physical activity (p=0.0001; OR=7.714; CI95% 2.868-20.751), high family income (p=0.0096; OR=2.202; CI95% 0.958-5.059), parental obesity status (p=0.0001; OR=24.5; CI95% 7.870-76.271), early introduction of complementary foods (p=0.0001; OR=4.567; CI95% 1.916-10.888), and non-exclusive breastfeeding (p=0.0005; OR=4.046; CI95% 1.605-10.201). The prevalence of childhood obesity in Teluk Pandan is 46% lower compared to urban areas in Indonesia. This study identifies several risk factors associated with childhood obesity in rural-coastal areas, including excessive food consumption, lack of physical activity, parental obesity, early introduction of complementary foods, and non-exclusive breastfeeding.

Anxiety Disorders: A Comprehensive Overview, Media Influences, and Age-Related Trends

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Excessive worry and anxiety in reaction to a range of events characterise anxiety disorders, a significant public health issue that impacts individuals of all ages. Comprehending the complex traits associated with anxiety, such as its connection with media and distinct effects on different age groups, is essential for developing comprehensive strategies for prevention, diagnosis, and therapy.  This paper provides an extensive overview of anxiety, exploring its definitions, diagnosis, and treatments. The information gathered on anxiety disorders is taken from official guidelines, medical journals, and academic research, all of which are conducted from between 2003 and 2023. This review consists of information that contained relevant topics, which are causes, treatment, definition, age groups, and effects from media. Since anxiety disorders are subjective in nature and may trigger symptoms that are mistaken with physical conditions, they are difficult to diagnose. Classification is done using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), however there are still issues with correctly diagnosing and treating anxiety.

One important topic covered in this paper is the effect of media on anxiety, particularly how social media, television, and journalism affect people’s mental health. Studies show that more social media use is linked to increased symptoms of anxiety, especially in emerging adults. Similarly, longer television viewing is associated with a higher rate of anxiety and depression among teenagers. Psychological distress can also be worsened by unpleasant events, like the COVID-19 pandemic being covered by the media.

The prevalence and consequences of anxiety differ among age groups. Anxiety disorders are prevalent in children and adolescents and frequently remain untreated, hindering their social and intellectual growth. In order to effectively manage anxiety in younger populations, psychological treatments such as cognitive-behavioral therapy are essential. On the other hand, anxiety in adults and the elderly is becoming increasingly recognised, with comorbid depressive disorders and specific phobias being more common in older people. The underestimation of anxiety symptoms in the elderly highlights the need for more specialized interventions and increased awareness.

Use of Digital Technologies: Family Perspectives on Children’s Health

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The increasing use of digital technologies among children and adolescents prompts concerns about their impact on development and necessitates family mediation. This study explored primary caregivers’ views on the effects of screen exposure on child health through a focus group with 20 caregivers (17 mothers and 3 grandmothers, aged 20 to 40) from an elementary school in Irecê, Bahia. Findings indicate that children’s screen time, including TV and mobile phones, often lacks proper time and content control due to caregivers’ extensive responsibilities such as remote work and household chores. Major concerns were exposure to violent games, deceptive online profiles, and potential interactions with abusers. Notable behavioral issues in children included irritability, aggression, and sleep problems. Caregivers implemented mediation strategies like setting rules, time restrictions, content filters, and discussing digital self-care. The discussion also addressed addiction mechanisms, family screen habits, gender differences in electronic device usage, and their health impacts on children. An agreement was made to limit screen use across the family, especially an hour before bedtime, aiming to enhance children’s sleep quality and thereby improve their mood and academic performance. This condensed study underscores the challenges caregivers face with children’s digital access and stresses the importance of effective mediation strategies. Enhanced parental engagement and school collaboration are crucial for fostering healthier digital habits that benefit children’s health and family well-being.

 

Obesity as a Problem in Children and Adolescents: Literature Review

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Obesity in children and adolescents affects health worldwide and is linked to premature death, comorbidities in the cardiometabolic and psychosocial systems, and other conditions. The problem of obesity in children and adolescents is 10% for children aged 5 to 17 years and 2-3.5% for teenagers, according to the most recent official data. The number of adolescents and children in Indonesia who suffer dietary deficiencies has risen every year. Adolescent obesity is caused by a variety of factors. The effects of childhood obesity can range from psychosocial effects to lifelong clinical changes like hypertension, hypercholesterolemia, metabolic syndrome, orthopedic disorders, obstructive sleep apnea (OSA), asthma, fatty liver disease, and increased risk for cardiovascular disease. Local, regional, and global efforts are encouraged by the World Health Organization’s (WHO) strategy on diet, physical activity, and healthier lifestyle.

Social and Psychological Challenges Facing Orphaned Children Living in the Orphanage Centres in Tanzania

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The study aimed to assess social and psychological challenges facing orphaned children living in the orphanages in Tanzania. The motivational theory of Abraham Maslow guided this study with the use of the qualitative approach. In-depth interviews were employed to collect data from the research participants. The study was carried out in four orphanage centres within three wards in Dar es Salaam Region. A purposive sampling technique was employed to get 29 participants for this study. Specifically, the study intends to answer the following unexplored questions: i) What are the social challenges facing orphaned children living in the orphanages? ii) What are the psychological challenges facing orphaned children living in the orphanages? The findings revealed that in the orphanages orphaned children experienced various social challenges including shortage of basic needs, shortage of educational materials, and lack of sport gears as well as poor health services. They also faced psychological challenges like physical punishment, bullying behaviours from fellows, segregation, isolation and poor attachment from their caregivers. Such challenges are indicators for defining ineffectiveness of   caregivers in providing psychosocial services to orphaned children. The study concluded that in the present context, orphanages are not a good residence for orphans’ psychosocial wellbeing due to shortage of funds and presence of untrained personnel. The study recommended that, the government should formulate interventional policies and enact laws which would look after the welfare of orphaned children rather than depending on the institutional Care.

 

Comparative Evaluation of Analgesic Effectiveness of Various Anesthelic Drugs in Combination with Dexmedetomidine in Children after Cardiac Surgery

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In pediatric practice, for postoperative pain therapy, in addition to analgesia, sedation must also be taken into account in order to prevent the development of delirium and irritation to discomfort. Therefore, the purpose of our work was to evaluate the efficacy and safety of various forms of non–opioid drugs in combination with dexmedetomidine in children with congenital heart defects after cardiac surgery. The study included 60 children aged 2 to 4 years with congenital heart defects operated on for radical corrections of congenital heart defects in conditions of artificial circulation. The patients were divided into 2 groups, identical in anthropometric data. All patients underwent sedation and analgesia with dexmedetomidine, paracetamol and diclofenac. After the conducted examinations and observations, it was concluded that the use of non–opioid analgesics in combination with dexmedetomidine gives good results in the postoperative period, without causing any special complications from organs and systems.

The Influence of Parental Divorce on Children’s Character Development

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This study aims to investigate the impact of parental divorce on children’s character development in a city in Indonesia. This used a case study qualitative method. Data was collected through direct observation, and in-depth interviews with divorced parents, children, and religious court staff. Written materials were also analyzed to find out the divorce cases handled at the city religious court. This study found that the causes of divorce are included economic limitation, domestic violence, betrayal, and longer conflict. The impact of the divorce on children’s character development included unstable children’s emotions, such as stress and mental pressure, dropping out of education, decrease children’s confidence and a lack of trust of the children to their parents. However, this study also found that the divorce also caused a positive impact on the children’s character in which the children become more independent and stronger in their lives. We suspect the divorce might have caused some children to build positive perceptions from their painful life. As such they take it as a positive life experience and then caused them to become more stronger and independent. Future research should focus on why some children perceive their parent’s divorce as a negative experience, while others accept it as a positive life experience and use it as a factor to be independent and stronger.