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Introduction: Spinal tuberculosis (TB) is an extrapulmonary form of TB that affects the spine. The Bacillus Calmette-Guérin (BCG) vaccination program, which has been implemented to prevent TB, should have prevented this type of TB. However, cases of this disease in children can still be found. This study aimed to determine whether there was a relationship between BCG vaccination and the occurrence of spinal TB in children. Methods: This case-control analytic observational study was performed based on medical record data. The study subjects of each group, both case and control, were taken from pediatric TB patients at Dr. Soetomo General Academic Hospital, Surabaya, from 2017 to 2021. Patients with malnutrition and/or human immunodeficiency virus (HIV) infection were excluded. Statistical analyses were performed using Fisher’s exact test. Results: There were 9 patients in total within each group. Most were 12-17 years old, and the ratio of male by female was 1.25:1. There were 4 out of 9 (44%) spinal TB patients and 9 of 9 (100%) patients with no spinal TB who all received BCG vaccination. The statistical test indicated a significant (p=0.029) and moderate (C=0.527) relationship between BCG vaccination and the occurrence of spinal TB in children. Conclusion: The Bacillus Calmette-Guérin vaccination should be able to prevent the new occurrence of spinal TB in children.

Background Since children are more likely than adults to become infected with Mycobacterium tuberculosis or suffer from tuberculosis (TB), it is important to identify the risk factors of TB in children with adult household TB contacts. Objective To identify the risk factors of TB in children with adult household TB contacts. Methods This cross-sectional study was conducted at the Pediatric Respirology Inpatient Ward and Outpatient Clinic at Dr. Soetomo Hospital, Surabaya, Indonesia, using medical records of hospitalized patients from 2010 to 2018. Patients were children below 18 years of age who had a history of adult TB household contact(s). We analyzed age at TB diagnosis, nutritional status, BCG vaccination status, and HIV status as possible risk factors of TB. Results A total of 367 children with adult household TB contacts were included in our study. Age of

Introduction: Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), is a highly contagious airborne disease. High-risk environments with frequent close interactions contribute to the spread of TB. This study examined latent TB infection (LTBI) epidemiology in such settings to inform public health interventions and strategies to curb TB transmission in similar environments. Methods: This cross-sectional observational study, conducted from January to August 2022 at two boarding schools in Bangkalan, involved 100 adolescents aged 10-18 years old tested for latent tuberculosis infection using interferon-gamma (IFN-γ) release assay (IGRA). Data were collected via questionnaires. Bivariate analysis was used to determine the correlation between latent tuberculosis infection prevalence and each research variable using Pearson Correlation and odds ratio (OR) to find risk factors for each variable. A p

Background Observational studies have linked low vitamin D (VD) levels to increased asthma attacks in children. Subsequent meta-analyses of adults and children revealed that VD treatment might benefit asthmatic patients by reducing the incidence of exacerbations. Therefore, this review aims to analyze the effects of VD supplementation in reducing asthma exacerbations in children.Methods Published reports from PubMed, Cochrane, and Google Scholar were systematically searched until April 2023. The study protocol was registered in the PROSPERO database CRD42023411796. Randomized controlled trial studies were included in this review. Meta-analysis was performed using Cochrane RevMan 5.1 and presented with 95% confidence intervals (CIs).Results Ten relevant studies enrolled 1243 asthmatic children (631 children receiving vitamin D3 supplementation, 612 children receiving placebo) were included in this review. Our pooled analysis found that VD supplementation had a significant effect on lowering the total number of asthma exacerbations (RR 0.62; 95% CI: 0.44, 0.87; p = 0.01). Subgroup analysis revealed that a daily dose of VD given based on standard daily dose recommendation had a significant improvement on asthma exacerbations [(RR 0.41; 95% CI: 0,18, 0,92; p = 0.03).Conclusions Vitamin D supplementation can lower the occurrence of exacerbations in children with asthma, along with the improvement of FEV1.

Educating and empowering the community through tuberculosis cadres is crucial in the early detection of latent tuberculosis infection (LTBI) in primary healthcare settings. From the wide variety of educational media that can be used, flipcharts and booklets have a strong impact on engaging the participants through visual media. Therefore, this community service aims to determine the effect of education through flipcharts and booklets on TB cadres to increase LTBI finding in children. A total of 20 TB cadres of Dr. Soetomo Primary Health Care Surabaya participated in this study. Statistical analysis to evaluate the difference between the pre-test and post-test was used with the Wilcoxon test. The result of the pretest showed insufficient knowledge about latent tuberculosis with an average score of 74%. The post-test average score of 91% indicated a 17% increase in score. There was a significant difference in the score of the test before and after giving the material (p=0.001), indicating an increase in LTBI knowledge of the TB cadres after giving health education using flipchart and booklet as evidenced by the increase in average score between pre-test and post-test.

Highlight: • Pediatric tuberculosis patients profile using the medical records was determined. • The most pediatric tuberculosis patients under five years have pulmonary tuberculosis. • Pediatric tuberculosis patients received BCG immunization had a contact with adult tuberculosis patients histories. Abstract: The prevalence of tuberculosis (TB) in Indonesia is 391 per 100,000 population with the number of deaths around 110,000 cases in 2016. This study is descriptive research that aims to determine the profile of pediatric TB patients using the medical records at Taman public health center the period 2016-2019 with a total sampling technique. The sample in this study were 31 pediatric patients aged 0-14 years with a history of TB. Pediatric TB patients aged >5 years (58.1%) and who aged ≤5 years (41.9%). Pediatric TB patients had pulmonary tuberculosis (83.9%) and those who had extrapulmonary tuberculosis (16.1%). Pediatric TB patients aged ≤5 years had good nutritional status (32%) and who had poor nutritional status (27.2%). Meanwhile, pediatric TB patients aged >5 years had poor nutritional status (22.7%) and who had good nutritional status (18.1%). Pediatric TB patients who had a history of contact with adult TB patients (86.7%) and who did not have a history of contact with adult TB patients (13.3%). Pediatric TB patients who had received BCG immunization (86.2%) and who had not received BCG immunization (13.8%). This study concludes that most pediatric TB patients are >5 years old, almost all pediatric TB patients have pulmonary tuberculosis. Pediatric TB patients aged ≤5 years are more likely to have good nutrition. Meanwhile, there were more pediatric TB patients aged >5 years who had poor nutritional status. Almost all pediatric TB patients had a history of contact with adult TB patients and had received BCG immunization.

Introduction: Tuberculosis is one of ten leading causes of death worldwide, including Indonesia. Indonesia is one of seven countries that causes 64% deaths due to tuberculosis. Tuberculosis is caused by Mycobacterium tuberculosis through droplet nuclei in the air. It can occur to any group age, including children and adolescent, if there is a contact history of people with tuberculosis infection. In 2016, one million children had tuberculosis and around 250,000 children died because of tuberculosis. This study aimed to know the profile of tuberculosis in children and adolescent at Dr. Soetomo General Hospital Surabaya. Methods: This was a descriptive study using retrospective approach. Sample of this study was collected from electronic medical record provided by Dr. Soetomo General Hospital Surabaya using statistic formula of single sample for estimated population proportions of children and adolescent with tuberculosis from 2013-2017, with total samples of 149 people. Results: There were 149 samples of children and adolescent patients with tuberculosis. Most of the children were mostly 0-4 years old and 57% were female. 84% of the children had been immunized with BCG and classified as moderate, and 35% were under nutritional status. This study showed that 67% of the children in household contacts of adult tuberculosis patients also had tuberculosis. The most frequent symptoms of tuberculosis in children and adolescent were fever (72%) and cough (80%). Conclusion: Tuberculosis in children and adolescent is more likely to occur in children than adolescent, especially children within group age of 0-4 years old. The number of pulmonary tuberculosis in children and adolescent are higher than extrapulmonary tuberculosis.

Introduction: Asthma is a disease marked by bronchial hyperresponsivity. It is commonly seen in children and often affects their quality of life. Many factors affect asthma, including breastfeeding. Bioactive and immunological components of maternal milk have a protective effect on allergic asthma. However, some studies denied this, stating that it had no significant association to asthma. This study aimed to analyze the correlation between breastfeeding duration and the severity of allergic asthma described by the frequency of asthma attacks, sleep disorder, and activity limitation. Methods: This analytic observational study used a cross sectional approach. The subjects were pediatric outpatients aged 1 – 5 years old with allergic asthma at Pediatric Clinic of Dr. Soetomo General Hospital Surabaya and Private Pediatric Clinic from September 2019 to July 2020. Subjects were assessed based on the history of exclusive breastfeeding duration, frequency of asthma attacks, sleep disorder, and activity limitation through an interview using questionnaire. Results: Through the data obtained from 62 respondents, duration of exclusive breastfeeding showed no significant relation to the frequency of asthma attack (rs = -0.227, p = 0.076), sleep disorder (rs = -0.214, p = 0.095), and activity limitation (rs = -0.055, p = 0.672). Conclusion: There was no correlation between the duration of exclusive breastfeeding and the frequency of asthma attack, sleep disorder, and activity limitation.

Introduction: Hospital-Acquired Pneumonia (HAP) is a nosocomial pneumonia that brings negative impacts, such as prolonged hospital stay and increased cost. Previous studies often discussed about the risk factors of HAP mortality in adult patients rather than in children. This study aimed to analyze the risk factors of mortality in children with HAP. Methods: This was a retrospective observational analytic study using cross sectional method with total sampling. A total of 73 children were enrolled in this study, consisted of inpatients at Pediatric Inpatient Room Dr. Soetomo General Hospital Surabaya who met the inclusion and exclusion criteria. Independent variables were gender, age, onset of HAP, length of stay (LOS), comorbidities, birth weight, type of breastfeeding, the use of mechanical ventilation (MV), and response to therapy. Dependent variable was mortality. The data were collected from medical records, which later were analyzed by bivariate and multivariate analysis. Results: The mortality of children with HAP was 23.3%. Bivariate analysis showed that age (p = 0.009), the use of MV (p = 0.029), and response to therapy (p = 0.036) were proven to affect mortality in children with HAP in Dr. Soetomo General Hospital Surabaya. In addition, the use of MV was the significant risk factor (p = 0.023) given by the multivariate analysis. Gender, onset of HAP, LOS, comorbidities, and type of breastfeeding were not proven to be the risk factors for mortality. Conclusion: Mortality in children with HAP in Dr. Soetomo General Hospital Surabaya was significantly affected by children’s age, the use of MV, and response to therapy. This information might be used as early signs and treatment strategies for children with HAP which lead to the decrease of hospital mortality

Background: Acute respiratory tract infection (ARTI) is one of the causes of morbidity and mortality in children. This infection may happen in either the upper or lower respiratory tracts. It may also happen recurrently in some children according to the risk factors they have. This study aimed to understand the correlation between risk factors and recurrent upper respiratory tract infection in children aged 3-60 months at primary healthcare centers (Puskesmas) in Gresik. Methods: This study used an analytic observational study with cross-sectional design. The amount of sample used was 110 patients with upper respiratory infection from October 2019-April 2020 at Puskesmas Industri and Puskesmas Alun-Alun, Gresik. Data analysis was performed using chi-square test and logistic regression. The data were taken from medical records as well as questionnaires. Results: The result of bivariate analysis showed that asthma (p = 0.000), exposure to cigarette smoke (p = 0.045), healthy home status (p = 0.002), and the occupancy of the house (p = 0.019) had correlations with the occurrence of recurrent upper respiratory infection. Meanwhile, the multivariate analysis presented some variables which had significant correlation with recurrent upper respiratory tract infection such as asthma (p= 0.000), exposure to cigarette smoke (p = 0.012), and healthy home status (p = 0.001). Conclusion: There was a strong relationship between asthma, exposure to cigarette smoke, and healthy home status with the occurrence of recurrent upper respiratory tract infection (URTI) in children.

The diagnosis of childhood tuberculosis remains a challenge worldwide. The GeneXpert MTB/RIF test, a rapid Mycobacteria tuberculosis diagnostic tool, was recommended for use in children. No pediatric studies of GeneXpert MTB/RIF assessing pulmonary tuberculosis within a hospital setting has been done in Indonesia. We evaluated the performance of the GeneXpert MTB/RIF test compared with sputum culture on Lowenstein-Jensen (LJ) for the diagnosis of childhood pulmonary tuberculosis. This study was conducted in pediatric respirology inpatient and outpatient Dr. Soetomo Hospital, a tertiary care facility in Surabaya between June and August 2015 with a cross-sectional design. We consecutively enrolled 27 children aged 3 months to 14 years who had history of close contact with adult tuberculosis patients and showed symptoms of pulmonary tuberculosis. Sputum collection was performed by induced sputum and three examination methods were performed (microscopic, GeneXpert MTB/RIF and sputum culture) simultaneously followed by a drug sensitivity test for specimens detected with MTB growth. The GeneXpert MTB/RIF test had a sensitivity of 100% (95% CI 100-100) and a specificity of 95% (95% CI 85-100). The positive predictive value for diagnosing pulmonary TB was 89% (95% CI 68-100), the negative predictive value was 100% (95% CI 100-100) and positive likelihood ratio was 20 (95% CI 2.82-128). The GeneXpert MTB/RIF test on one sputum sample rapidly and correctly identified all children with culture-confirmed pulmonary tuberculosis with high specificity. Similar results were obtained between GeneXpert MTB/RIF and sputum culture based on age groups and clinical manifestations. Rifampicin resistance were both detected in GeneXpert MTB/RIF and MTB sensitivity test

Background: Background The presence of remodeling process on the pathogenesis of asthma that involves some growth factors such as epidermal growth factor (EGF) and fibroblast growth factor (FGF) causes the chronicity of the disease. The role of zinc on the pathogenesis of asthma is being widely investigated. This study aimed to analyze the correlation between EGF and FGF2 and clinical improvement of asthma after zinc supplementation. Methods: A quasi-experimental study was conducted in Outpatient Clinic Dr. Soetomo Hospital. The samples were persistent asthma patients from 6-15 years old who received controller therapy. The samples were divided into 2 groups, those who received zinc supplementation as the intervention group, and who received pacebo as the control. EGF and FGF2 plasma level of both groups were measured, and clinical improvement was evaluated with Childhood Asthma Control Test (C-ACT). Results: There were 11 patients who received zinc supplementation and 12 patients in the control group. There was a significant difference (p = 0.000) on the increase of EGF level in the intervention group (55.59 ± 6.48) than the control (5.35 ± 5.55). There was a significant difference (p = 0.000) on the increase of the FGF2 level in the intervention group (6.37 ± 1.41) than the control (0.72 ± 0.48). The increase of EGF (r = 0.592; p = 0.003) and FGF2 (r = 0.607; p = 0.002) would be followed by the increase of C-ACT scores. Conclusion: Zinc supplementation increase EGF and FGF2 levels. This improvement is correlated with clinical improvement of patients.

BACKGROUND: Risk of acute respiratory infections in children less than 5 years of age is up to 95%. Zinc deficiency is one of the main risk factors. This study aimed to explore the effect of zinc on the bronchial mucosae inflammatory status expressed by nuclear factor (NF)-κB p105/p50, NF-κB p65, interleukin (IL)-8, and IL-1β. METHODS: Twenty-four Wistar rats were divided into 4 groups: normal zinc diet group without zinc supplementation (Z1), normal zinc diet group with zinc supplementation (Z2), zinc deficient diet group without zinc supplementation (Z3), and zinc deficient diet group with zinc supplementation (Z4). NF-κB p105/p50, p-NF-κB p65, IL-8, and IL-1β were measured by immunohistochemical staining. RESULTS: The inflammatory status of bronchial mucosae between Z1 and Z2 groups showed no difference (p=0.055). However, the inflammatory status of bronchial mucosae between Z3 and Z4 groups showed significant difference (p

Background: The impact of COVID-19 may be more severe in developing countries. Our study aims to analyze the accuracy of several inflammatory biomarkers in predicting COVID-19 mortality, providing information about the most suitable markers for developing countries. Methods: A retrospective cohort study was conducted at Dr. Soetomo General Hospital, Indonesia, from March to June 2020. White Blood Cells (WBC) count, Neutrophil-Lymphocyte Ratio (NLR), Procalcitonin (PCT), D-Dimer, and C-Reactive Protein (CRP) have been collected from the electronic medical records. We performed survival analysis to provide the hazard ratio and Receiver Operating Characteristic (ROC) curve analysis to test for accuracy for each parameter. Results: A total of 423 patients who met the criteria for participating had a median age of 54 (IQR 45-61) years. Patients in the death group are characterized by older age and shorter length of hospitalization. The WBC, NLR, PCT, D-Dimer, and CRP are found significantly higher in the death group (P=0.000). The WBC, NLR, PCT, D-Dimer, and CRP have an Area Under the Curve (AUC) of 0.709, 0.773, 0.738, 0.721, and 0.769, respectively moderate accuracy in predicting COVID-19 patient mortality. We found that NLR is significantly more accurate than the age parameter (Z=3.527; P=0.000) but has equal accuracy with other laboratory parameters. Conclusions: Since NLR obtained the highest accuracy, we still recommend routine complete blood count tests as prognostic biomarkers with the highest feasibility to be performed in developing countries.

Introduction: Pneumonia is the world-leading cause of death in children under five years old and most prevalent in developing country. Proper initial diagnosis will determine further management, because pneumonia and severe pneumonia have different treatment. The aim of this study was to describe the prevalence of pneumonia severity in children under five years old at primary health setting. Methods: This study was a cross – sectional descriptive study on medical records of children aged 2 to 59 months with pneumonia at primary health care of Tambakrejo, Surabaya from September to December 2017. Severity of pneumonia is classified using its clinical sign such as fast breathing, fever, chest indrawing, and general danger sign. The data were processed using Microsoft Office Excel and statistically analyzed with SPSS IBM 20. Results: There were 31 respondents that were diagnosed with pneumonia at primary health care of Tambakrejo, Surabaya from September to December 2017. Most of the children diagnosed with pneumonia were aged 12 to 59 months (61.3%) and 22.6 % of the children had severe pneumonia. Conclusion: Distribution of severity case of pneumonia at primary health care of Tambakrejo, Surabaya showed that there were more case of pneumonia with fast breathing than severe pneumonia or pneumonia with any general danger sign. Most of them were diagnosed at 12 to 59 months with a good nutritional status.

Latar belakang. Penyakit jantung bawaan (PJB) merupakan faktor risiko utama yang memperparah infeksi saluran pernapasan bawah akut. Infeksi saluran pernapasan bawah akut yang paling umum adalah pneumonia. Beberapa faktor predisposisi untuk pneumonia telah diidentifikasi, seperti pada malnutrisi berat. Tujuan. Untuk mengetahui faktor risiko kejadian pneumonia anak dengan penyakit jantung bawaan di RSUD Dr.Soetomo Surabaya. Metode. Jenis penelitian ini adalah analitik observasional dengan desain kasus kontrol berdasarkan data rekam medik pasien yang dirawat di Ruang Rawat Inap SMF Ilmu Kesehatan Anak RSUD Dr. Soetomo Surabaya selama periode Januari 2016 sampai dengan Desember 2016. Analisis data dilakukan dengan uji chi-square dan regresi logistik. Kriteria inklusi untuk kelompok kasus adalah pasien PJB dengan pneumonia, sedangkan kelompok kontrol pasien PJB tanpa pneumonia dengan umur 1 bulan sampai 60 bulan. Kriteria eksklusi adalah rekam medik yang tidak lengkap. Hasil. Diperoleh subjek sebesar 66 pasien, dengan perbandingan kasus-kontrol 1:1. Hasil analisis multivariat ditemukan adanya hubungan yang signifikan antara anemia dengan kejadian pneumonia pada anak dengan PJB (p=0,002) dan terdapat hubungan yang signifikan antara neuromuscular disease dengan kejadian pneumonia pada anak dengan PJB (p=0,015). Kesimpulan. Adanya hubungan antara anemia dan neuromuscular disease dengan pneumonia pada anak dengan penyakit jantung bawaaan.

BACKGROUND: Airway epithelium is the first line of defense against a variety of exposures. Inflammatory processes, hyperresponsiveness and zinc deficiency cause epithelial damage. Zinc is involved in apoptosis and microtubule formation. However, its role in the integrity of bronchial mucosa and cilia is unclear. METHODS: To assess the effect of zinc on the integrity of the bronchial epithelium, 24 male Rattus norvegicus strain Wistar rats were randomized into four experimental groups: normal zinc diet group without zinc supplementation, normal zinc diet group with 60 ppm zinc supplementation, zinc deficient diet group without zinc supplementation, and zinc deficient diet group with 120 ppm zinc supplementation. Bronchial mucosal integrity was measured with the number of epithelial cells, and the number and length of cilia. RESULTS: Number of cell in normal zinc diet group was 8.8±1.82, while it was only 8.1±1.08 in zinc deficient diet group (p

Background Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in the pediatric intensive care unit (PICU), with mortality rates of up to 50%. Post-mortem pulmonary examination is considered to be the gold standard for diagnosis of VAP, but is impossible for routine application. The sensitivity and specificity of Clinical Pulmonary Infection Score (CPIS) are considered to be similar to the those of the gold standard, but the Centers for Disease Control and Prevention PNU-1 (CDC PNU-1) is simpler and not invasive, compared to the CPIS. Objective To evaluate the level of agreement between CDC PNU-1 and CPIS criteria in diagnosing VAP. Methods This cross-sectional study was conducted in the PICU at Dr. Soetomo Hospital, Surabaya from June to October 2018. Subjects were children aged 1 month–18 years who had been intubated for more than 48 hours. The VAP diagnoses were made by CDC PNU-1 and CPIS criteria. The level of agreement between the two methods was evaluated by Cohen’s Kappa test using SPSS Statistics Base 21.0 software. Results hirty-six subjects were evaluated using CDC PNU-1 and CPIS criteria. Subjects’ mean age was 3.5 (SD 4.7) years. Amongst 19 patients with VAP, 14 were diagnosed by CPIS criteria and 17 were diagnosed by CDC PNU-1 criteria. The level of agreement between the CDC PNU-1 and CPIS criteria was good (Kappa 0.61; 95%CI 0.31 to 0.83). The CDC PNU-1 had sensitivity 0.85, specificity 0.77, positive predictive value (PPV) 0.70, and negative predictive value (NPV) 0.89. Conclusion The CDC PNU-1 criteria has a good level of agreement with CPIS criteria in diagnosing VAP.

Background: Over the past 10 years, infection has remained as the main cause of illness and mortality among children with Acute Lymphoblastic Leukemia on chemotherapy. The high incidence of Hospital-Acquired Pneumonia in children with Acute Lymphoblastic Leukemia on chemotherapy with risk factors should be intervened earlier Methods: An observational case control study of children with Acute Lymphoblastic Leukemia on chemotherapy. Patient with Hospital-Acquired Pneumonia considered as case and patient without Hospital-Acquired Pneumonia as control to analyze risk factors that affect the incidence of Hospital-Acquired Pneumonia in children with Acute Lymphoblastic Leukemia on chemotherapy from 2016 to 2018 was performed in the pediatric ward Dr. Soetomo General Academic Hospital with a total sampling technique. Nine risk factors were analyzed: age, gender, nutritional status, length of stay, risk stratification, chemotherapy phase, anemia, neutropenia, and thrombocytopenia. Bivariate and multivariate analysis using chi-square, continuity correction, and logistic regression was used for statistical analysis. Results: 120 children enrolled the study. Analyzed of risk factors showed risk stratification (p = 0.009), chemotherapy phase (p < 0.001), and neutropenia (p < 0.001) was proven to significantly affect the incidence of Hospital-Acquired Pneumonia in children with Acute Lymphoblastic Leukemia on chemotherapy. Age, gender, nutritional status, length of stay, anemia, and thrombocytopenia were not proven to be a risk factor that affects the incidence of Hospital-Acquired Pneumonia in children with Acute Lymphoblastic Leukemia on chemotherapy. Conclusion: The incidence of Hospital-Acquired Pneumonia in children with Acute Lymphoblastic Leukemia on chemotherapy is significantly affected by the risk stratification, chemotherapy phase, and neutropenia.

Increasing awareness of the rising global rates of multidrug-resistant tuberculosis (MDR-TB) has led to a concerted international effort to confront this disease. Nonetheless, despite cure rates >80% in some programs, MDR-TB patients tend to have chronic disease and require prolonged therapy.1-3 Little is known about the long-term results and follow-up of patients with MDR-TB, include the recurrence rate and chronic disability in patients who have recovered from TB.4 There are many side effects and adverse reactions to drugs can occur during MDR-TB treatment. These could be physical and or psychological, as well as reversible or irreversible. Treatment of MDR-TB requires a combination regimen, consists of second and third-line anti-tuberculosis drugs which more toxic than first-line drugs. Additionally, MDR-TB treatment requires a long duration of treatment (18-24 months) and causes discomfort in the patient.5 In a cohort of 60 patients treated for MDR-TB, the most common side effects included gastritis (100%), dermatological disorders (43%), and peripheral neuropathy (16.7).6 While in a cohort of 75 patients, the incidence of depression, anxiety, and psychosis for MDR-TB treatments was 13.3%, 12.0%, and 12.0%, respectively.7 Aggressive and effective management are needed so the patient can tolerate the treatment and remain adhere the treatment.8 Long-term follow-up is required for the rehabilitation of disorders due to psychosocial sequelae. As such, psychosocial support can be benefit pediatric MDR-TB patients. Here, we present a case report on a two-year follow-up of a pubertal child with MDR-TB, focusing on medical aspects and her development.

Latar belakang. Pneumonia masih menjadi salah satu penyebab utama morbiditas dan mortalitas anak balita di seluruh dunia. Red-cell distribution width (RDW) dan mean platelet volume (MPV) adalah dua parameter dalam pemeriksaan darah lengkap yang sederhana, murah, dan tersedia hampir di seluruh rumah sakit di Indonesia. Penggunaannya sebagai biomarker keparahan pneumonia dapat menjadi salah satu upaya untuk menurunkan morbiditas dan mortalitas akibat pneumonia. Tujuan. Menganalisis hubungan antara nilai RDW dan MPV dengan derajat keparahan pneumonia anak. Metode. Penelitian cross-sectional dilaksanakan pada Juni-November 2017 di RSUD Nganjuk, melibatkan 30 anak berusia 2-59 bulan dengan pneumonia. Nilai RDW dan MPV dihubungkan dengan klasifikasi diagnosis, derajat keparahan yang diukur menggunakan skor RISC (respiratory index of severity in children) dan PRESS (pediatric respiratory severity score), dan hasil terapi pneumonia. Hasil. Terdapat perbedaan bermakna pada nilai RDW antara subjek dengan pneumonia dan pneumonia berat (t28=-1,721, p=0,096). Nilai RDW antara kelompok dengan nilai PRESS rendah, sedang, dan tinggi juga berbeda bermakna (F(2,27)=4,083, p=0,028). Nilai RDW berhubungan bermakna kuat dengan klasifikasi diagnosis pneumonia (x(1)=0,530, p=0,004), dan berhubungan bermakna moderate dengan skor RISC (rs=0,369, p=0,023), serta skor PRESS (rs=0,318, p=0,043). Kesimpulan. Nilai RDW berhubungan dengan klasifikasi diagnosis pneumonia, skor RISC dan skor PRESS.

Background Miliary tuberculosis (TB) is a fatal form of tuberculosis with severe clinical symptoms and complications. The mortality rate from this disease remains high, therefore, it is important to identify the risk factors for miliary TB for early detection and treatment. Objective To identify risk factors for miliary tuberculosis in children. Methods A case-control study of children aged 0-14 years with miliary TB was conducted in Dr. Soetomo Hospital from 2010 to 2015. Data were taken from medical records. Case subjects were children with miliary TB, and control subjects were children with pulmonary TB . Patients with incomplete medical records were excluded. Case subjects were identified from the total patient population; control subjects were included by purposive sampling, with case:control ratio of 1:1. Potential risk factors were age, nutritional status, BCG immunization status, and history of contact with TB patients. Statistical analyses were done with Chi-square and logistic regression tests. P values < 0.05 were considered to be statistically significant. Results A total of 72 children were analyzed, with 36 case and 36 control subjects. Nutritional status had a significant associatation with miliary TB in children (OR 3.182; 95%CI 1.206 to 8.398; P=0.018) in both bivariate and multivariate analyses. The probability of a child with moderate or severe undernutrition developing miliary TB was 76.09%. Other factors were not significantly associated with miliary TB. Conclusion Nutritional status is significantly associated with miliary TB in children, and moderate or severe undernutrition increases the risk for developing miliary TB.

Latar belakang.Deteksi dini infeksi bakteri dan infeksi virus pada anak sangat penting untuk tata laksana antibiotik lebih dini. Prokalsitonin (PCT) merupakan suatu temuan baru sebagai petanda serologis yang bisa dipercaya. Belum banyak informasi tentang akurasi diagnostik PCT untuk spektrum penyakit infeksi di negara berkembang. Tujuan.Melakukan akurasi diagnostik PCT sebagai petanda serologis untuk membedakan infeksi bakteri dan infeksi virus pada anak. Metode.Penelitian prospektif dengan desain potong lintang dilakukan di Departemen Ilmu Kesehatan Anak RSU Dr. Soetomo Surabaya, dari September 2009 sampai November 2010. Pasien dibagi dalam kelompok infeksi bakteri dan infeksi virus (sebagai kontrol). Data demografi, pemeriksaan darah tepi, CRP and PCT dievaluasi. Analisis statistik menggunakan uji studentt dan uji Mann Whitney U dengan interval kepercayaan 95% dan bermakna jika nilai p

Introduction: Pneumonia is an infectious disease attacking lower respiratory tract. It has one of the highest number of world’s mortality and morbidity in children. Many risk factors are suspected as the reasons why the disease still occur a lot. One of the major risk factors is birth weight which makes their immune system immature and easier to get various complications and infections. The aim of this study is to analyze birth weight as risk factor of pneumonia in children under 5 years old. Methods: This was an analytical study with case control design. This study was held in Primary Health Care of Tambakrejo, from August to December 2017. The sample size was 22 respondents for each case and control group. Technique of sampling was total sampling. Secondary data were collected by medical records at the health center and Kartu Menuju Sehat (KMS). Data were entered into Microsoft Excel then statistically analyzed using IBM SPSS 22. The data were analyzed by Fisher’s Exact Test. Results: During August to December 2017, there were 22 respondents which were diagnosed with pneumonia in Tambakrejo Primary Health Center. Two of them (4.55%) had low birth weight and the rests had normal birth weight (95.45%). The analyze result stated that there is no significant correlation between pneumonia incidence and birth weight. Conclusion: Birth weight is one of pneumonia risk factors without significant impact.

This study was intended to invent a simpler and more affordable method to establish diagnosis on Tuberculosis (TB) and Latent Tuberculosis infection (LTBI). Similar to “Quantiferon TB Gold In Tube” (QFT-GIT) and T.SPOT.TB methods, the researchers also utilized “early secreted antigenic target 6kDa” (ESAT-6) and “cultur filtrate protein 10kDa” (CFP-10) proteins to be induced on the specimen. ESAT-6 and CFP-10 are commercial products used to induce interferon gamma (INF-γ) which were to be read using sophisticated and expensive equipment. This study was intended to conduct an analysis on effective cocktail protein modification, i.e. ESAT-6, CFP-10 and Ag85A/B/C, with high validity to detect cellular immunity activity through in vitro examination on peripheral blood monocyte cells of Tuberculosis-suspected patients or patients with latent tuberculosis infection. Peripheral Blood Monocyte Cells (PBMCs) activity on children tuberculosis patient or Latent Tuberculosis Infection (LTBI), adult tuberculosis patient or LTBI, which induced by cocktail protein modification and not induced, were analyzed microscopically. The activity of PBMCs on children and adult tuberculosis patient or LTBI induced by RD1 secretory proteins: ESAT-6, CFP-10, Ag85A/B/C was higher compared to PBMCs which had not been induced by the secretory proteins. Cellular debris and monocyte cells with abnormal shapes were found on PBMCs which had been induced by RD1 secretory proteins at 8 th day after culture.

Background Pneumonia has been one of the serious problems for children under five in Indonesia. Imbalanced interactions among host factors, agents, and environments influence incidence of pneumonia. Objective To determine the risks of the host related to the incidence of pneumonia in children aged 3-59 months in Pediatrics Department, Dr. Soetomo General Hospital during 2011-2012. Methods This was a case control study on medical records of patients with respiratory infections in Pediatrics Department, Dr. Soetomo General Hospital. We grouped patients with pneumonia as the case group and patients with other respiratory infections as the control group. The data were statistically processed to calculate odds ratios and P values. Results There were 326 subjects reviewed, 163 in the case group and 163 in the control group. Host factors that increased the risk of pneumonia were: low birth weight (OR=3.10; 95%CI 1.34 to 6.86), inadequate exclusive breastfeeding (OR=1.7; 95%CI 1.09 to 2.64), malnutrition (OR=3.44; 95%CI 2.12 to 5.58) and incomplete immunization in a certain period of age (OR=2.70; 95%CI 1.72 to 4.24). Existed comorbidity was unrelated to the incidence of pneumonia (OR=1.53; 95%CI 0.86 to 2.71). Conclusion Low birth weight, inadequate exclusive breastfeeding, malnutrition, and incomplete immunization in a certain period of age increase the risk of pneumonia.

Background: Community Acquired Pneumonia (CAP) is one of the most important health problem affecting children all over the world. Clinical findings, laboratory and radiological examination of CAP may largely vary from mild to severe. Objective: To report profile of CAP in children hospitalized at Soetomo Hospital Surabaya in 2007–2008 Methods: This research was a retrospective study. Data of children with primary diagnosis of CAP in 2007–2008 were obtained from medical records of the Department of Child Health Soetomo Hospital Surabaya. The diagnosis CAP was based on WHO criteria (pneumonia clinical syndrome). The clinical features of illness, laboratory and radiological examination were recorded and presented descriptively. Results: During the study period, 438 patients were diagnosed as CAP. More than half (83.4%) patients aged 3 months– 3 year. Beside cough and tachypnea, most common symptom and signs were chest indrawing (76.2%) and fever (23.8%). Leucocytosis (39.6%). Bacteria was found in 8.2%. Accompanying diseases (i.e congenital heart disease, neurological and gastroenterological disorders) were found in 36.4%. One hundred fifty seven patients (35.8%) had malnutrition. Patchy infiltrate was found in 80.8% chest X-ray examination. Mortality was found in 4.3%. Conclusions: Community acquired pneumonia in children still count as a major problem at Soetomo Hospital Surabaya.

Background: Influenza is a viral infection that attacks the respiratory system (nose, throat, and lungs) that commonly known as “flu”. There are 3 types of influenza viruses, such as type A, type B, and type C. Influenza virus type A is the type of virus that can infect both human and animals, virus type B are normally found only in human, and Influenza virus type C can cause mild illness in human and not causing any epidemics or pandemics. Among these 3 types of influenza viruses, only influenza A viruses infect birds, particularly wild bird that are the natural host for all subtypes of influenza A virus. Generally, those wild birds do not get sick when they are infected with influenza virus, unlike chickens or ducks which may die from avian influenza. Aim: In this study, we are identifying the influenza viruses among poultry in Larangan wet market. Method: Around 500 kinds of poultry were examined from cloacal swab. Result: Those samples were restrained with symptoms of suspected H5. The people who worked as the poultry-traders intact with the animal everyday were also examined, by taking nasopharyngeal swab and blood serum. Conclusion: Identification of influenza viruses was obtained to define the type and subtype of influenza virus by PCR.