Socially, economically, politically and emotionally (SEPE) disadvantaged children are shorter than children from affluent background. In view of previous work on the lack of association between nutrition and child growth, we performed a study in urban schoolchildren. We measured 723 children (5.83 to 13.83 years); Kupang, Indonesia; three schools with different social background. We investigated anthropometric data, clinical signs of malnutrition, physical fitness, parental education, and household equipment. Subjective self-confidence was assessed by the MacArthur test. The prevalence of stunting was between 8.5% and 46.8%. Clinical signs of under- or malnutrition were absent even in the most underprivileged children. There was no delay in tooth eruption. Underprivileged children are physically fitter than the wealthy. The correlation between height and state of nutrition (BMI_SDS, skinfold_SDS, MUAC_SDS) ranged between r = 0.69 (p < 0.01) and r = 0.43 (p < 0.01) in private school children, and between r = 0.07 (ns) and r = 0.32 (p < 0.01) in the underprivileged children. Maternal education interacted with height in affluent (r = 0.20, p < 0.01) and in underprivileged children (r = 0.20, p < 0.01). The shortness of SEPE disadvantaged children was not associated with anthropometric and clinical signs of malnutrition, nor with delay in physical development. Stunting is a complex phenomenon and may be considered a synonym of social disadvantage and poor parental education.

BackgroundDiphtheria has been reported as an outbreak in some regions in Indonesia, most especially in East Java Province. Resistance to penicillin, erythromycin, and other antibiotics, single or multiple, has been reported in several studies. This study aims to evaluate the first-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae isolates.MethodsThis descriptive observational study was performed from August to November 2018. C. diphtheriae isolates were collected from diphtheria patients and carriers in East Java from 2012 to 2017 and kept at the Balai Besar Laboratorium Kesehatan Daerah Surabaya or the Public Health Laboratory of Surabaya. Sample selection was done by random cluster sampling. The sensitivity test by E-test®of the five antibiotics (penicillin, oxacillin, erythromycin, azithromycin, and clarithromycin) was done to determine the minimum inhibitory concentration (MIC). The Clinical and Laboratory Standards Institute M45A (2015) Corynebacterium spp. for penicillin and erythromycin was used as standard.ResultsFrom 114 targeted isolates, 108 were viable and toxigenic. The E-test was performed on the viable isolates. The majority of the hosts were male (58.3%), with median (range) age of 6.5 (1–14) years. Half of the samples were from the 1 to 5-year-old age group. The isolates were acquired much more from patients (78.7%) than carriers (21.3%) and from pharyngeal swab (74.1%). Most of these isolates were from Madura Island (47.2%) and the northern and eastern parts of the province (horseshoe area). Mitis isolates were the major variant (76.9%). The susceptibility pattern of C. diphtheriae to erythromycin was better than that to penicillin. The E-test result for penicillin was 68.52% susceptible, 31.48% intermediate, and 0% resistant (MIC range, < 0.016 to 2 μg/L) and for erythromycin (MIC range, < 0.016 to > 256 μg/L) was 85.2% susceptible, 12% intermediate, and 2.8% resistant The MIC range for oxacillin was 1 to 96 μg/L, while for both azithromycin and clarithromycin were <  0.016 to > 256 μg/L.ConclusionThe susceptibility rate of C. diphtheriae to erythromycin is higher than that to penicillin. The regular update of antibiotic selection to the national guidelines is recommended. The MIC reference standard to azithromycin and clarithromycin is also needed.

Pendahuluan: Penyakit difteri telah ditetapkan menjadi kejadian luar biasa di berbagai wilayah di Indonesia, sebagian besar kasus berasal dari Jawa Timur. Tujuan: Mengetahui profil isolat Corynebacterium diphtheriae toksigenik di Jawa Timur. Metode. Penelitian deskriptif, dilakukan 20 Agustus sampai 30 November 2018. Isolat yang diteliti dipilih secara cluster random sampling kemudian dilakukan uji viabilitas dan toksigenisitas di BBLK Surabaya. Isolat yang viabel dan toksigenik dilakukan analisis karakteristik. Hasil: Penelitian ini melibatkan 114 isolat, 6 tidak viabel, 108 viabel dan toksigenik. Jenis kelamin pejamu ialah 58,3% laki-laki, 41,7% perempuan. Usia median 6,5 tahun (termuda 1 tahun, tertua 14 tahun). Mayoritas pada kelompok usia 1-5 tahun (50%) disusul 6-10 tahun (30,6%) dan 11-15 tahun (19,4%). Wilayah asal isolat didominasi dari Madura (47,2%) dan Jawa Timur tapal kuda (32,4%), sedangkan Jawa Timur bukan tapal kuda hanya 20,4%. Lokasi pengambilan sampel 74,1% dari usap tenggorok dan 25,4% dari usap hidung. Varian mitis mendominasi sejumlah 76,9%, sedangkan varian gravis hanya 23,1%. Kesimpulan: Isolat Corynebacterium diphtheriae toksigenik terbanyak didapatkan pada pejamu kelompok usia 1-5 tahun, mayoritas berdomisili di Madura dan Jawa Timur tapal kuda. Isolat terutama didapat dari usap tenggorok pasien. Varian mitis mendominasi dalam penelitian ini.

Background: Stunting in the infant can caused by a history of exclusive breastfeeding and report of anemia during pregnancy and can also affect growth in the first 1000 days of life. Research Objective: Research objective was to identify the relationship between the mother's history of anemia during pregnancy on the antenatal care examination and the history of exclusive breastfeeding given to infants aged 6-12 months with stunting in Kuanheun Village and Bolok Village. Method: The method is Cross-sectional. This research was assess in august-September 2022. The total number of respondents was 39 people. The inclusion criteria used; like to become research respondents, respondents who had toddlers aged 6-12 months in Kuanheun Village and Bolok Village, and respondents who brought Maternal and Child Health (MCH) books of the study subject. The data type used was the history of Antenatal Care (ANC) in the mother's MCH book and anthropometric measurements on the infant. Results: Spearman's rho test there was no significant association between the history of ANC K4 anemia and the incidence of stunting in infants 6-12 months p = 0.7 >0,05 and there was no significant association between the history of exclusive breastfeeding and the incidence of stunting in infants 6-12 months p = 0.1 >0,05. Conclusion: There is no relationship between the report of anemia in ANC K4 and the history of exclusive breastfeeding with the incidence of stunting in infants aged 6-12 months in Kuanheun Village and Bolok Village.

Adrenal Crisis is an acute deterioration of adrenal insufficiency. This condition leads to an emergency condition. The major manifestation of adrenal crisis is hypotension and shock hypovolemic. Unspecified general manifestation would lead to misdiagnosis and suboptimal management of this condition. Comprehensive understanding, early diagnosis, and prompt management are important to prevent morbidity and mortality risks in children with adrenal crisis.