Background. In dengue infection, it is difficult to differentiate mild and severe dengue prior to its critical phase. Ability to identify risk factors for severe dengue form patients’ initial presentation would help decrease the need of hospitalization, increase physicians’ awareness, and improve outcome.Objective. To predict pediatric dengue infection severity based on initial patient characteristics, routine clinical and laboratory profiles. Methods. This was a cross-sectional study based on medical records of children with dengue infection in Atma Jaya Hospital, Jakarta. Inclusion criteria were children aged 1 – 18 years old with proven dengue infection, hospitalized in Atma Jaya Hospital during January – December 2016. Clinical profiles and laboratory parameters at the time of patient presentation were extracted and analyzed in relationship with dengue severity. Result. Data collected was 110 patients with mean age 9.5 years old. Initial clinical profiles that significantly related to severe dengue were: age ≤5 years old (OR = 0.113, p = 0.001), hepatomegaly (OR = 2.643, p = 0.035), pleural effusion (OR = 9.545, p = 0.000), platelet ≤125,000/uL (OR = 0.201, p = 0.025), hyponatremia (OR = 10.139, p = 0.000) and AST >135 u/L (OR = 5.112, p = 0.014). Gender, duration of fever, additional symptoms, spontaneous bleeding, blood pressure, pulse pressure, hematocrit, leucocyte, random blood glucose, calcium, and ALT were not related significantly to dengue severity.Conclusion. Physician should be cautious in pediatric dengue patients presented in age younger than 5 years old, with hepatomegaly and/or pleural effusion, platelet below 125,000/uL, hyponatremia, and AST more than three times upper normal limit. These patients have higher risk of severe dengue than patients without those findings.

Objectives To report a neonate with clinical findings consistent with thanatophoric dysplasia (TD). Only a few cases of this rare and lethal skeletal disorder have been reported in South-East Asia. Case presentation A 37-year-old Asian female, fourth gravida at 39 weeks, presented to our hospital for an elective cesarean section due to polyhydramnios, frank breech and gestational hypertension. The father was a 42-year-old Asian male. There was no history of rashes, fever, alcohol intake, substance drug abuse, smoking habit or radiation exposure. Ultrasound (US) of 34-weeks’ gestation found a baby with frontal bossing, prominent temporal lobe, clover-skull and low nasal bridge. The thoracic diameter was smaller than the abdominal diameter. Short limbs without bowing were noted in femur and humeral bones. The patient delivered a baby boy, 4115 g, APGAR scores were 5 and 7 at 1 and 5 min. The baby had a dysmorphic face, frontal bossing, low nasal bridge, low-set ears and short neck. The thorax was narrow and abdomen was protuberant. The upper and lower proximal limbs appeared short. A chest X-ray revealed short, curved ribs and opacification of both lungs. He had respiratory distress shortly after birth and had persistent severe respiratory distress despite adequate mechanical ventilation. On the third day, he had cardiac arrest; resuscitation was not done due to family request. The baby was declared deceased due to cardiopulmonary failure related to his congenital anomaly. Conclusions Ultrasonography could readily indicate TD prenatally. The pregnancy can continue up to late third trimester without miscarriage. Most of the neonates die in utero; those who survive are dependent on ventilator.

No abstract

Basic immunization coverage in Indonesia in 2013 was still low (59.2%) (IBHS, 2013). Physicians' attitude and practice were among the determinant factors of a successful immunization program. This survey aimed to describe general practitioner's (GP) and pediatrician's attitude towards immunization and its coverage in private practices. This cross-sectional study was performed by distributing questionnaires consisting of 5 items on opinion and 10 items on immunization practices to 100 respondents in November 2014. Completed questionnaires were obtained from 29 GPs and 65 pediatricians. Most respondents considered that the Expanded Program in Immunization vaccine should be given. First dose of hepatitis B vaccine was mostly given in the first 12 hours after birth (90% GPs and 74% pediatricians). Oral polio vaccine was mostly given shortly before hospital discharge (65% of GPs and 81% pediatricians) while the DTwP-HB-Hib vaccine were given by 27% of GPs and 21% of pediatricians to >75% patients. Pneumococcal, rotavirus, hepatitis A, typhoid, and influenza vaccines were provided by less than 25% GPs and pediatricians, except for the influenza vaccine which was provided by 31% pediatricians. MMR vaccine was given to >75% patients by 16% of GPs and 29% of pediatricians. This pilot survey of immunization practice in private setting might be the first study in Indonesia that this can be considered as a preliminary report of immunization in private setting. Further studies need to be done, especially regarding problems in immunization in private practices. [MKB. 2017;49(4)

<p>Background<br />Pediatric nephrolithiasis is an important cause of morbidity worldwide. Even with low prevalence, nephrolithiasis can cause detrimental long-term effects on kidney function. Idiopathic hypercalciuria is the most common cause of renal stones in children. This case report presents a pediatric patient with bilateral nephrolithiasis and hydronephrosis associated with underlying idiopathic hypercalciuria.</p><p>Case description<br />We report on a 17-month-old boy presenting with two days of high fever, irritability, nausea, and poor feeding. The patient had been diagnosed with bilateral nephrolithiasis at the age of 6 months. On examination, the patient was febrile and hypertensive. Laboratory evaluation revealed anemia, leukocytosis, normokalemia, normocalcemia, and normal glomerular filtration rate. Blood gases were within normal limits. Urinalysis revealed pH 5.0, hematuria, pyuria, and bacteriuria. Urine culture was positive for Proteus mirabilis and Enterobacter gergoviae. Electrolyte analysis from urine samples revealed hypercalciuria. Ultrasonography found stones at the left ureteropelvic junction with corresponding grade I hydronephrosis and stones in the right lower calyx without hydronephrosis. The patient was treated with antibiotics, an antihypertensive agent, thiazide diuretics, and was referred to a pediatric urologist.</p><p>Conclusion<br />This case can be considered as idiopathic. Most children with renal stones have metabolic risk factors including enteric, endocrinologic, or renal sources. Metabolic evaluation is mandatory in pediatric renal stone patients and hypercalciuria is an important etiology to be evaluated. Ignorance of the underlying metabolic abnormality or failure in its identification in pediatric urolithiasis could lead to catastrophic long-term effects.</p>

Background. In dengue infection, it is difficult to differentiate mild and severe dengue prior to its critical phase. Ability to identify risk factors for severe dengue form patients’ initial presentation would help decrease the need of hospitalization, increase physicians’ awareness, and improve outcome.Objective. To predict pediatric dengue infection severity based on initial patient characteristics, routine clinical and laboratory profiles. Methods. This was a cross-sectional study based on medical records of children with dengue infection in Atma Jaya Hospital, Jakarta. Inclusion criteria were children aged 1 – 18 years old with proven dengue infection, hospitalized in Atma Jaya Hospital during January – December 2016. Clinical profiles and laboratory parameters at the time of patient presentation were extracted and analyzed in relationship with dengue severity. Result. Data collected was 110 patients with mean age 9.5 years old. Initial clinical profiles that significantly related to severe dengue were: age ≤5 years old (OR = 0.113, p = 0.001), hepatomegaly (OR = 2.643, p = 0.035), pleural effusion (OR = 9.545, p = 0.000), platelet ≤125,000/uL (OR = 0.201, p = 0.025), hyponatremia (OR = 10.139, p = 0.000) and AST >135 u/L (OR = 5.112, p = 0.014). Gender, duration of fever, additional symptoms, spontaneous bleeding, blood pressure, pulse pressure, hematocrit, leucocyte, random blood glucose, calcium, and ALT were not related significantly to dengue severity.Conclusion. Physician should be cautious in pediatric dengue patients presented in age younger than 5 years old, with hepatomegaly and/or pleural effusion, platelet below 125,000/uL, hyponatremia, and AST more than three times upper normal limit. These patients have higher risk of severe dengue than patients without those findings.

Juvenile myelomonocytic leukemia (JMML) is a rare hematopoietic malignancy in children, with an incidence of 1.2 per million children per year. At this moment, we present a case report and a brief literature review of JMML in a child, primarily focused on its applicability in low-middle income countries. A 3.5-year-old male was referred to our tertiary center due to pallor, enlarging abdomen and neck mass, recurrent fever, and chronic diarrhea. Initial laboratory workup showed hemoglobin of 6.4 g/dl, white blood cell of 315.62 × 103/μL, and platelet of 17 × 103/μL. Blood smears showed 10% suspected blasts, 17% myelocytes, and 17% metamyelocytes with thrombocytopenic crisis. The HbF level was 5.8%. BCR-ABL gene tested negative. The patient was diagnosed with juvenile myelomonocytic leukemia. Considering that HSCT could not be done in our center and lack other financial possibilities to seek treatment abroad, the family agreed to do the palliative treatment. The patient was treated with oral 6-mercaptopurine and subcutaneous cytarabine. Four weeks after receiving 6-mercaptopurine, the white blood cell count decreased to 10.6 × 103/μL and the spleen size was half of the original size. The patient continued chemotherapy until week 15, chemotherapy was stopped, but 16 weeks after the diagnosis of JMML, he developed severe thrombocytopenia, endophthalmitis, and sepsis and passed away. As a conclusion, in JMML cases in developing countries without HSCT, palliative chemotherapy is acceptable, and palliative care is an important aspect.