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Visfatin levels in non-obese, obese, and insulin resistant adolescents Indra Ihsan; Eka Agustia Rini; Rismawati Yaswir
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Background Adipose tissue is not merely a site for energy storage, but is also the largest endocrine organ, secreting various adipocytokines. Plasma visfatin, an adipocytokine predominantly secreted from visceral adipose tissue, has insulin-mimetic effects, and has been closely linked to insulin resistance.Objective To compare plasma visfatin levels between obese and non-obese adolescents, as well as between obese adolecents with and without insulin resistance.Methods This cross-sectional study was conducted in students who attended three senior high schools in Padang. Subjects comprised 28 obese and 28 non-obese adolescents. The age of the subjects ranged from 14-18 years. Obesity criteria were based on body mass index (BMI) measurements. Fasting serum glucose level was measured by glucose hexokinase photometry and serum insulin was measured by chemiluminesence immunoassay. Plasma visfatin was measured by enzyme-linked immunosorbent assay (ELISA). The insulin resistance index was estimated from fasting serum insulin and glucose levels using the homeostatic model assessment for insulin resistance (HOMA-IR). Differences in the variables were tested using independent T-test and Mann-Whitney test, depending on the distribution of the variables.Results The mean plasma visfatin level was significantly higher in the obese than in the control group [2.55 (SD 1.54) vs. 1.61 (SD 0.64) ng/mL, respectively; (P=0.005)]. The insulin resistant group had significantly higher mean plasma visfatin level than the non-resistant group [3.61 (SD 1.59) vs. 1.96 (SD 1.18) ng/mL, respectively; (P=0.004)].Conclusion Obese adolescents with insulin resistance have signifcantly higher plasma visfatin levels compared to those without insulin resistance.

Delayed diagnosis of congenital hypothyroidism in an adolescent results in avoidable complications: a case report Indra Ihsan; Eka Agustia Rini
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society

Delayed diagnosis of congenital hyporhyroidism (CH) remains a serious problem. A retrospective analysis of 1,000 CH cases in Turkey found a mean age of 49 months at the time of clinical diagnosis. Only 3.1% of cases were diagnosed during the neonatal period and 55.4% were diagnosed after 2 years of age.1 In Cipto Mangunkusumo Hospital, Jakarta, 53% cases were diagnosed at 1-5 years, 3.3% at 6-12 years, and 6.7% after 12 years of age, while the remainder were diagnosed at < 1 year of age.2 The majority of affected children exhibit signs and symptoms that are highly non-specific, as most infants with CH are asymptomatic at birth, and only 5% of cases can be diagnosed based on clinical examination during the first day of life.3 The other factors that contribute to delayed diagnosis are uneducated parents, who do not notice or dismiss the importance of mild/moderate deviations in physical and mental growth, as well as constipation, feeding difficulties, or other vague, non-specific symptoms in infancy. Parents are often unaware of the importance of early diagnosis and commencement of therapy for CH.4

Hubungan status vitamin D dengan mortalitas dan lama rawatan pada anak sakit kritis Nice Rachmawati; Indra Ihsan
Majalah Kedokteran Andalas Vol 40, No 2 (2017): Published in September 2017
Publisher : Faculty of Medicine, Universitas Andalas

Vitamin D memiliki peranan dalam pertahanan tubuh melawan infeksi. Vitamin D menghambat proliferasi sel otot polos vaskuler, melindungi endotel, dan memodulasi proses infeksi. Defisiensi vitamin D akan menyebabkan defek fungsi makrofag seperti kemotaksis, fagositosis, dan produksi sitokin pro-inflamasi. Defisiensi vitamin D akan memberikan luaran yang buruk pada anak sakit kritis. Tujuan: Untuk mengetahui hubungan kadar dan status vitamin D terhadap mortalitas dan lama rawatan pada anak sakit kritis. Metode: Studi potong lintang dilakukan di PICU RSUP M. Djamil Padang sejak Agustus sampai November 2016. Dilakukan penghitungan skor Pelod-2, pemeriksaan kadar serum vitamin D dan kalsium, dan dihubungkan dengan mortalitas serta lama rawatan. Hubungan antar variabel dianalisis statistik menggunakan t-Test, Mann-Whitney, Chi-square dan Kruskal-Wallis. Hasil: Diperoleh prevalensi insufisiensi dan defisiensi vitamin D pada anak sakit kritis adalah 37,50% dan 44,64%. Dari 56 subjek, 19 subjek meninggal dunia (33,92%). Skor Pelod 2 pada awal rawatan berhubungan dengan mortalitas (p=0,001). Tidak terdapat hubungan antara status vitamin D dengan mortalitas (p=0,732) dan lama rawatan (p=0,311) pada anak sakit kritis. Simpulan: Bahwa sebagian besar anak sakit kritis mengalami insufisiensi dan defisiensi vitamin D, namun status vitamin D tidak berhubungan dengan tingkat mortalitas dan lama rawatan.

Profil Klinis dan Luaran Syok Sepsis pada Pasien Anak yang Dirawat di PICU RSUP Dr. M. Djamil Padang Yoga Gandha Prasetya; Indra Ihsan; Amirah Zatil Izzah
Jurnal Ilmu Kesehatan Indonesia Vol 1 No 3 (2020): November 2020
Publisher : Fakultas Kedokteran, Universitas Andalas

Background. Septic shock is a common pediatric emergency with a high mortality rate. Objective. The purpose of this study was to determine the clinical profile and outcome of septic shock in pediatric patients treated at PICU of DR. M. Djamil Padang State General Hospital. Method. This descriptive study used data from medical records, conducted in the Medical Record Department of DR. M. Djamil Padang State General Hospital. The target population was pediatric patients which was diagnosed with septic shock in PICU through 2015 - 2017. Samples were collected by the total sampling technique. Result. During the following study of ninety-one patients septic and forty-eight having septic shock. Children having septic shock were commonly under one year of age, female, low nutritional status, having central neuron system infection of Klebsiella sp, having less than two organ dysfunctions with clinical manifestations of Hyperthermia, Tachycardia, and Tachypnea. Hematological profile found that patients commonly had anemia, leukocytosis, thrombocytopenia, and normal I/T ratio. Shock septic outcomes were found high mortality rate, almost some patients use a ventilator, high inotropic usage, and length of stay in living patients compared to dead. Conclusion. The study concluded that prevalence Septic Shock pediatric still high with higher mortality and also morbidity

SARS-CoV-2 Serology Antibody in Children with MIS-C (Multiple Inflammatory Syndrome in Children) Suspected Finny Fitry Yani; Indra Ihsan; Efrida
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 10 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i10.572

Background: Multiple inflammatory syndromes in children (MIS-C) relate to COVID-19 severity in children. SARS-CoV-2 serology antibody is one of the diagnostic tools of MIS-C. The study aimed to describe the yield of serology antibodies of MIS-C and some characteristics found in hospitalized children with MIS-C suspects. Methods: This research was an analytic observational study. The data were collected retrospectively from some children who were hospitalized in Dr. M. Djamil General Hospital, Padang, West Sumatra, Indonesia, from April - June 2021. The inclusion criteria were children aged 1 month to 18 years, with or without contact history with the person who probable or confirmed COVID-19 and have signs and symptoms as MIS-C base on WHO criteria. Results: About eight out of 44 children showed positive serology antibodies and were diagnosed as MISC (18,2%). Based on demographic characteristics, children aged 11-15 years (27.3%) and boys were more affected (52.3%) as MIS-C suspected. Most of them were referred from a 2nd-level hospital outside Padang City (70.4%), but only 13.6% had a history of contact with COVID-19 confirmation patients. There was a significant difference in cardiovascular signs and symptoms between positive and negative serology antibody SARS-CoV-2 among children with MIS-C suspected (p<0.05), but not in fever, respiratory distress, gastrointestinal, neurology symptoms, either in laboratory results such as leukocytes, CRP and D-dimmer. Intravenous immunoglobulin, steroid, and PICU admitted showed no significant differences between the 2 groups, but more death prevalence in positive than negative. However, no significant differences (12.5% vs. 11.1%, p>0.05). Conclusion: Cardiovascular signs and symptoms could be proposed to be one of the significant differences in clinical conditions to differentiated children with MIS-C suspected and MIS-C due to serology antibody results.

Case Presentation : Congenital Tuberculosis in A Premature Infant Presented with Miliary Tuberculosis Indra Ihsan; Aldian Tri Wahyuda Putra; Mutia Rahman
Scientific Journal Vol. 4 No. 5 (2025): SCIENA Volume IV No 5, September 2025
Publisher : CV. AKBAR PUTRA MANDIRI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56260/sciena.v4i5.280

Congenital tuberculosis (TB) is a rare neonatal infection resulting from vertical transmission of Mycobacterium tuberculosis from mother to infant. Fewer than 500 cases have been reported worldwide, with a high mortality rate up to 40%. Diagnosis is challenging due to its nonspecific presentation and resemblance to neonatal sepsis. We report a case of a 1-month-old preterm infant admitted with worsening respiratory distress, fever, and cough. Chest X-ray revealed a “snow storm appearance” consistent with miliary tuberculosis. The infant’s mother had a history of chronic cough prior to pregnancy and later tested positive for Mycobacterium tuberculosis by sputum PCR. The sputum PCR test in the infant also returned positive. Laboratory findings included leukocytosis with neutrophil predominance and elevated transaminases. The infant was given respiratory support with CPAP and treated with a standard four-drug antitubercular regimen (2HRZE/10HR) and corticosteroids due to severe respiratory involvement. The clinical course was favorable, with resolution of respiratory symptoms and radiologic improvement, allowing discharge after 16 days of hospitalization. The diagnosis of congenital tuberculosis in this patient was confirmed based on the mother's history of suspected pulmonary tuberculosis prior to pregnancy, along with the confirmed diagnosis of tuberculosis through a positive sputum PCR test in the mother and the infant. Liver biopsy which is gold standard of diagnosis could not be performed due to the patient's unstable condition and the consideration of the benefit invasive procedure.Awareness of maternal risk factor for TB plays a pivotal role in suspected congenital tuberculosis, enables early diagnosis and prompt treatment, reducing mortality and long-term sequelae.

Leukoreduction therapy in pediatric malignant pertussis: a systematic review Melati Wijaya; Indra Ihsan; Rinang Mariko
Paediatrica Indonesiana Vol. 66 No. 1 (2026): January 2026
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background Malignant pertussis (MP) in children is a severe form of pertussis characterized by hyperleukocytosis, which can be life-threatening and requires appropriate treatment to reduce mortality. Objective To review the effectiveness of available leukoreduction therapy modalities for pediatric MP. Methods A systematic literature review was performed in adherence to PRISMA guidelines. We searched MEDLINE (PubMed), Google Scholar, and ScienceDirect and included studies in English published from 2005 to 2025 which involved leukoreduction modalities such as exchange transfusion (ET), leukapheresis, extracorporeal membrane oxygenation (ECMO) with leukofiltration (ECMO-LF), and hydroxyurea (HU) plus supportive care on children aged 0-5 years with MP. Results Twenty articles were identified involving 241 cases of MP. The median age was 2 (range 0.4-19) months. White blood cell (WBC) reduction was 67-74% with ET (n=92), 65.2% with leukapheresis (n=6), 83% with ECMO-LF (n=5), and 23-70% with HU (n=9). In contrast to the other modalities, HU provided gradual reduction. Survival was significantly higher in the leukoreduction group (52.7%) compared to the non-leukoreduction group (32.6%) (P<0.01). WBC-stratified subgroup analysis demonstrated that patients with WBC ≥70,000/mm³ had a lower survival rate than those with WBC>50,000 to <70,000/mm³ (47.2% vs. 60.0%; P=0.048). Among patients with WBC ≥70,000/mm³, leukoreduction provided higher survival than did supportive care (55.2% vs. 14.3%; P=0.031; NNT=2.4). No significant difference in survival was observed in those with WBC >50,000/mm3 to <70,000/mm³ receiving leukoreduction vs. supportive care (57.1% vs. 66.7%; P=0.626). Conclusion Early identification of mortality risk factors and prompt management prior to organ dysfunction are essential for reducing mortality. Leukoreduction therapy should be considered for patients with WBC ≥70,000/mm³. Hydroxyurea may serve as an alternative non-invasive therapeutic option.

Enzyme-Inducing Antiseizure Medications and Hypovitaminosis D in Children with Epilepsy: A Cross-Sectional Study in West Sumatera, Indonesia Trisna Yunita; Rahmi Lestari; Nice Rachmawati Masnadi; Eva Chundrayetti; Amirah Zatil Izzah; Indra Ihsan; Rinang Mariko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1642

Background. Long-term antiseizure-medication (ASM) therapy can accelerate vitamin D catabolism via hepatic cytochrome P450 induction, predisposing children with epilepsy to hypovitaminosis D and its skeletal consequences; Indonesian tertiary-centre data remain scarce. Methods. This cross-sectional study examined the association between ASM class, number and duration and serum 25-hydroxyvitamin D [25(OH)D] in children aged 1–18 years at Dr. M. Djamil General Hospital, Padang, West Sumatera, between April and October 2025. Of 82 records screened, 77 were eligible; 25(OH)D was measured by enzyme-linked fluorescent assay, with hypovitaminosis D defined as <30 ng/mL. Associations were tested with Fisher–Freeman–Halton exact and chi-square tests, odds ratios, ANOVA, multivariable logistic regression and ROC analysis. Results. Hypovitaminosis D affected 48 children (62.3%; 95% CI 51.2–72.3), with mean 25(OH)D of 18.3±6.7 versus 41.6±11.2 ng/mL in deficient versus replete children. ASM class was significantly associated with vitamin D status (exact p=0.037; Cramér's V=0.283): all nine enzyme-inducing users were deficient, versus 56.0% non-enzyme-inducing and 58.1% combination (ANOVA p=0.045, η²=0.080). Neither ASM number (p=0.642) nor duration (p=0.348) was associated. Enzyme-inducing exposure carried the largest adjusted odds (adjusted OR 5.66, 95% CI 0.62–52.06), and the model discriminated moderately (AUC 0.685). Conclusion. Hypovitaminosis D is prevalent in Indonesian children with epilepsy and is most strongly linked to enzyme-inducing ASMs, supporting early routine 25(OH)D monitoring and supplementation from treatment initiation.

Enzyme-Inducing Antiseizure Medications and Hypovitaminosis D in Children with Epilepsy: A Cross-Sectional Study in West Sumatera, Indonesia Trisna Yunita; Rahmi Lestari; Nice Rachmawati Masnadi; Eva Chundrayetti; Amirah Zatil Izzah; Indra Ihsan; Rinang Mariko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1642

Background. Long-term antiseizure-medication (ASM) therapy can accelerate vitamin D catabolism via hepatic cytochrome P450 induction, predisposing children with epilepsy to hypovitaminosis D and its skeletal consequences; Indonesian tertiary-centre data remain scarce. Methods. This cross-sectional study examined the association between ASM class, number and duration and serum 25-hydroxyvitamin D [25(OH)D] in children aged 1–18 years at Dr. M. Djamil General Hospital, Padang, West Sumatera, between April and October 2025. Of 82 records screened, 77 were eligible; 25(OH)D was measured by enzyme-linked fluorescent assay, with hypovitaminosis D defined as <30 ng/mL. Associations were tested with Fisher–Freeman–Halton exact and chi-square tests, odds ratios, ANOVA, multivariable logistic regression and ROC analysis. Results. Hypovitaminosis D affected 48 children (62.3%; 95% CI 51.2–72.3), with mean 25(OH)D of 18.3±6.7 versus 41.6±11.2 ng/mL in deficient versus replete children. ASM class was significantly associated with vitamin D status (exact p=0.037; Cramér's V=0.283): all nine enzyme-inducing users were deficient, versus 56.0% non-enzyme-inducing and 58.1% combination (ANOVA p=0.045, η²=0.080). Neither ASM number (p=0.642) nor duration (p=0.348) was associated. Enzyme-inducing exposure carried the largest adjusted odds (adjusted OR 5.66, 95% CI 0.62–52.06), and the model discriminated moderately (AUC 0.685). Conclusion. Hypovitaminosis D is prevalent in Indonesian children with epilepsy and is most strongly linked to enzyme-inducing ASMs, supporting early routine 25(OH)D monitoring and supplementation from treatment initiation.

Long-Term Observation of a Child with Foreign Body Aspiration Pneumonia and Reccurent Cardiac Arrest from an Incarcerated Mothers Muhammad Reza Syahli; Asrawati Asrawati; Indra Ihsan; Fitrisia Amelin; Riki Alkamdani
Indonesian Journal of Global Health Research Vol. 8 No. 3 (2026): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v8i3.1459

This study employed a longitudinal case study design aimed at describing the clinical course, respiratory recovery, nutritional status, developmental progress, and social dynamics of a child with aspiration pneumonia accompanied by cardiac arrest. The research subject was a one-year-old girl who experienced baked potato aspiration while living in a correctional facility with her mother. The patient received intensive treatment at Andalas University Hospital and was subsequently monitored for three consecutive semesters after discharge. Data collection was conducted through multiple sources to obtain comprehensive information. Clinical data during the acute phase were obtained through a review of the patient’s medical records, including physical examination findings, laboratory and radiological results, and records of medical interventions provided during hospitalization. Follow-up data were collected through direct clinical observation during routine control visits, focusing on respiratory recovery, nutritional status, and developmental progress. Child development was assessed using standardized developmental screening tools, namely the Denver Developmental Screening Test II (Denver II) and the Capute Scales (CAT-CLAMS). Additional contextual data were obtained through in-depth interviews with the child’s parents, correctional facility health workers, and healthcare providers at the referral hospital to understand the caregiving environment and health management after discharge. Home visits were also conducted after the mother returned from the correctional facility to evaluate the child’s living conditions, caregiving practices, and environmental factors that might influence recovery and development. Data analysis was carried out using a descriptive and thematic approach. Clinical and developmental data were analyzed longitudinally to identify patterns of recovery from the acute phase to the follow-up period across three semesters. The analysis also explored the interaction between medical factors (such as treatment response and clinical outcomes) and social factors (including caregiving environment and family support) in influencing the child’s recovery and development. All research procedures adhered to pediatric ethical principles, including maintaining the confidentiality of the patient’s identity and obtaining informed consent from the family for documentation and analysis of the case. This approach allows for a comprehensive understanding of the child’s recovery process, integrating both clinical and social perspectives.

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