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HIV stadium IV on ARV, Tuberculosis Paru dan Gizi Buruk Tipe Marasmus pada Anak Perempuan 10 tahun: Laporan Kasus Anniza Agustina; Kinanti Rahmadita; Shinta Nareswari
Medula Vol 12 No 4 (2022): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v12i4.539

Human Immunodeficiency Virus (HIV) infection remains a global problem, with nearly 38 million people infected worldwide. Tuberculosis (TB) is the most common opportunistic infection found in HIV patients. Malnutrition in children with HIV infection can be caused by various factors such as individual factors, namely the absorption and metabolism disorders of children. Reported a 10-year-old girl with complaints of fever, cough and weight loss. The patient has been diagnosed with HIV since 4 years ago. The HIV status of both parents is unknown. History of contact with adult TB, namely the patient's father. Physical examination found multiple submental and submandibular lymph nodes (KGB) measuring 1x1cm palpable soft. On auscultation of the lungs there were crackles in both lung fields. Nutritional status of malnourished patients with marasmus type. AP chest x-ray examination revealed a primary impression of TB. The medical therapy given was continuing antiretroviral drugs (tenofovir, lamivudine, and evapirenz), D5¼NS fluids 1200cc/day, antibiotics ceftriaxone 1.2g/24 hours, antipyretic paracetamol syrup 3x7.5ml, folic acid 1x5mg on the first day and 1x1mg on the next day, Vitamin C 2x50mg, vitamin B complex 1 tablet per day and salbutamol 3x1,5mg. Pulmonary TB was treated with rifampin 200 mg/day, isoniazid 140 mg/day, ethambutol 300 mg/day, and pyrazinamide 500 mg/day. Non-medical therapy in the form of oral nutrition, namely rice, side dishes, and milk with a total calorie of 55kcal/kgBW/day.

Obesitas pada Anak : Penyebab dan Konsekuensi Jangka Panjang Ananda Fitriliani; Bayu Anggileo Pramesona; Shinta Nareswari
Medula Vol 13 No 1 (2023): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v13i1.605

Obesity in children has reached epidemic levels in both developed and developing countries. Overweight and obesity in childhood are known to have a significant impact on physical and psychological health. Overweight and obese children tend to be obese into adulthood and are more likely to develop non-communicable diseases such as diabetes and cardiovascular disease at a younger age. The mechanism of obesity is not fully understood and is believed to be a disorder with various causes. In general, overweight and obesity are assumed to result from increased calorie and fat intake. On the other hand, there is supporting evidence that excessive sugar intake through soft drinks, an increase in portion size, and a steady decline in physical activity play a major role in the increase in obesity rates worldwide. Child obesity can greatly affect children's physical, social and emotional well-being, and self-confidence. It is also associated with poor academic performance and a lower quality of life experienced by children. Many comorbid conditions such as metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders have also been seen to be associated with childhood obesity. The growing problem of childhood obesity can be slowed, if society focuses on its causes. Overweight and obesity cannot be solved through individual actions alone. A comprehensive response is needed to create a healthy environment that can support individuals in making healthy choices based on knowledge and skills related to health and nutrition. This response requires government commitment and leadership, long-term investment, and whole-of-society engagement to protect children's right to good health and well-being. Progress can be made if all actors remain committed to working together towards the common goal of ending childhood obesity. This literature review discusses obesity in children by explaining what risk factors influence and long-term consequences for children.

Gastroesophageal Reflux Pada Anak Azzahra Gadis Junita Perdana; Shinta Nareswari
Jurnal Agromedicine Unila: Jurnal Kesehatan dan Agromedicine Vol. 10 No. 1 (2023): Jurnal Kesehatan dan Agromedicine
Publisher : Fakultas Kedokteran Universitas Lampung

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

Gastroesophageal reflux adalah pergerakan isi lambung kembali ke kerongkongan. Hal ini merupakan fenomena normal yang terjadi berkali-kali dalam sehari baik pada anak-anak maupun dewasa, tetapi, pada bayi, beberapa faktor berkontribusi untuk memperburuk fenomena ini, termasuk diet berbasis susu cair, posisi telentang dan struktural sertaketidakmatangan fungsional gastroesofagus. Gastroesophageal reflux (GER) menjadi gastroesophageal reflux disease (GERD) ketika refluks menyebabkan gejala dan/atau komplikasi yang mengganggu seperti masalah pernapasan dan pertumbuhan yang buruk. Diagnosis penyakit ini ditegakkan berdasarkan hasil anamnesis, pemeriksaan fisik danpemeriksaan penunjang seperti Kuesioner Infant Gastroesophageal Questionnaire (I-GERD), endoskopi disertai biopsi esofagus dan pemeriksaan pH esofagus. Dalam kebanyakan kasus, tidak diperlukan pengobatan untuk gastroesophageal reflux karena kondisinya sembuh sendiri. Pemberian makan yang kental, terapi postural, dan perubahan gaya hidup harus dipertimbangkan jika regurgitasi sering dan bermasalah. Farmakoterapi harus dipertimbangkan dalam pengobatan gastroesophageal reflux disease dengan tanda bahaya (red flag) dengan pertimbangan pemberian terapi empiris Proton Pump Inhibitor (PPI) / antagonis reseptor histamin 2 (AH2). Operasi antirefluks diindikasikan untuk pasien dengan gastroesophageal reflux disease yang signifikan yang resisten terhadap terapi medis. Untuk mendiagnosis GERD dibutuhkan pemahaman yang jelas oleh dokter sehingga dapat mengatasi gejala dengan tepat, mencegah komplikasi jangka panjang,dan mengurangi kecemasan orang tua. Tinjauan pustaka ini membahas gejala, cara diagnostik dan pengobatan gastroesophageal reflux pada anak Kata Kunci: Anak, Gastroesophageal, Reflux

Destroyed Lung in Children Undergoing Treatment for Pulmonary Tuberculosis: A Case Report Carissa Aprilia Yusanda; Shinta Nareswari
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i4.1919

Tuberculosis (TB) is a global health problem, especially in developing countries, with a high prevalence in South Asia and Sub-Saharan Africa. In 2019, there were around 1.2 million new cases of TB in children and 230,000 deaths from TB in children under 15 years of age. In Indonesia, the incidence of TB is very high, with more than 1 million people diagnosed in 2022, and 140,700 deaths from TB in the same year. One of the serious complications of TB is a destroyed lung, which is an advanced stage of pulmonary TB. This condition causes extensive and progressive damage to the lung parenchyma, disrupts lung function, and has the potential to cause respiratory failure, shortness of breath, secondary infections, and other complications. Although symptoms of TB often appear in the early stages, late diagnosis can worsen the prognosis and increase mortality. This case report analyzes a 13-year-old child patient who was referred to the hospital with complaints of cough, greenish sputum, and coughing up blood after recovering from chickenpox. Radiological examination showed atelectasis, bronchiectasis, and indications of destroyed lung. The diagnosis of pulmonary TB with destroyed lung was obtained after physical examination, laboratory, and other supporting examinations. The management includes treatment with antituberculosis drugs (OAT), antibiotics, supportive therapy, and pulmonary rehabilitation. Appropriate management can improve the patient's quality of life even though the prognosis is poor in the long term.

Pertussis and Bronchopneumonia in a One-Month-Old Infant: A Case Report: Pertussis and Bronchopneumonia in a One-Month-Old Infant: A Case Report Virgiansya Alhafiz; Shinta Nareswari
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i4.1932

Pertussis and bronchopneumonia are significant respiratory tract infections that cause high morbidity and mortality in young infants. The combination of these two conditions poses a severe clinical challenge, particularly in patients with an immature immune system who have not yet received immunization. This case report aims to discuss the diagnostic challenges regarding the CDC/WHO criteria for probable pertussis, the importance of intensive monitoring parameters, and the simultaneous management of atypical manifestations in young infants. A 1-month-11-day-old male infant presented with an 8-day history of paroxysmal cough, accompanied by post-tussive cyanosis, dyspnea, and nocturnal fever, with episodes of apnea. The patient had not received the DPT vaccination. Household contact tracing revealed that the patient's father had a history of chronic cough for the past 2 weeks and had not undergone any examination. Physical examination showed an oxygen saturation of 90% on room air and bilateral rhonchi. Laboratory evaluation revealed leukocytosis (14,900/mm³) with predominant relative lymphocytosis (68%) and thrombocytosis (561,000/μL). A chest X-ray demonstrated bilateral perihilar and right paracardiac infiltrates, confirming bronchopneumonia. Based on these findings, the patient was diagnosed with probable pertussis and bronchopneumonia. Therapeutic interventions included intravenous ampicillin-sulbactam, intravenous gentamicin, oral azithromycin, nebulized salbutamol + ipratropium bromide, and oxygen supplementation. The patient showed significant clinical recovery and was discharged on the fourth day of hospitalization. High clinical vigilance for pertussis and bronchopneumonia is vital when evaluating young infants presenting with paroxysmal cough, cyanosis, incomplete immunization status, and a history of close contact with an individual suffering from a chronic cough. The simultaneous administration of empirical macrolides and broad-spectrum antibiotics is effective in ensuring a successful clinical outcome.

Tuberkulosis Paru Anak dengan Hemoptisis dan Resistensi Rifampisin Indeterminate: Laporan Kasus Imtinan Khoirunnisa; Shinta Nareswari
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i4.1968

Tuberculosis (TB) in children remains a major contributor to global morbidity and mortality. Although clinical manifestations such as hemoptysis have been increasingly reported in adolescents, the primary diagnostic challenge in this case lies in the Molecular Rapid Test (TCM) GeneXpert result showing indeterminate rifampicin resistance. The patient's chest X-ray showed primary pulmonary TB, consistent with positive Mantoux and lipoarabinomannan (LAM) TB test results. TCM GeneXpert examination confirmed pulmonary TB bacteriologically, with MTB trace detected and indeterminate rifampicin resistance. In addition, Gram staining of sputum showed a mixed flora of bacteria and fungi, reflecting colonization or potential infection in the respiratory tract. The patient was diagnosed with bacteriologically confirmed pulmonary TB with hemoptysis and anemia due to chronic disease, and was well-nourished. Medical interventions included a first-line Anti-Tuberculosis Drug (OAT) regimen and symptomatic therapy. The patient's clinical outcome was excellent, characterized by the immediate cessation of hemoptysis post-tranexamic acid initiation and the achievement of overall clinical improvement during hospitalization. Overall, indeterminate rifampicin in TCM with a low (trace) bacterial load requires thorough clinical correlation to guide timely therapy.

Apnea Periodik akibat Patent Ductus Arteriosus Besar dan Bronkopneumonia pada Bayi Usia 2 Bulan Clara Arta Uli Rahel; Shinta Nareswari
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i4.1972

Patent Ductus Arteriosus (PDA) is a congenital heart defect resulting from the failure of ductus arteriosus closure after birth. A large PDA may produce a significant left-to-right shunt, leading to pulmonary overcirculation, heart failure, recurrent respiratory infections, growth failure, and apnea. This case report aims to describe the clinical presentation, diagnostic approach, and comprehensive management of an infant with periodic apnea associated with a large PDA complicated by bronchopneumonia. A 2-month-old female infant was admitted with cold extremities, cyanosis, and recurrent episodes of apnea lasting more than 20 seconds, occurring 4 hours before hospitalization. The patient also had a productive cough, respiratory distress, and poor weight gain since birth. Physical examination revealed tachypnea, subcostal and substernal retractions, cold extremities, a continuous cardiac murmur, and undernutrition with a body weight of 2.7 kg. Chest radiography demonstrated right bronchopneumonia, while echocardiography confirmed the presence of a large PDA. The patient was diagnosed with periodic apnea secondary to a large PDA, accompanied by bronchopneumonia, undernutrition, and incomplete basic immunization. Management consisted of oxygen therapy, intravenous antibiotics, bronchodilator nebulization, captopril and furosemide administration, and high-calorie nutritional support. After 10 days of hospitalization, significant clinical improvement was observed, including resolution of apnea and cyanotic episodes, reduced respiratory distress, hemodynamic stabilization, and weight gain to 2.9 kg. This case highlights the importance of considering congenital heart disease in infants presenting with recurrent respiratory symptoms, apnea, and failure to thrive to ensure timely diagnosis and comprehensive management.

Acute Kidney Injury (AKI) et causa Sindrom Nefrotik dengan Komponen Nefritik pada Anak: Laporan Kasus Auriva Renasha Suherman; Shinta Nareswari
Medula Vol 16 No 4 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v16i4.1980

Acute Kidney Injury (AKI) is a clinical syndrome characterized by a sudden decline in kidney function, resulting in disturbances of fluid and electrolyte balance and the accumulation of metabolic waste products. In children, AKI may occur secondary to various underlying conditions, including nephrotic syndrome with nephritic components. This case report aims to describe the clinical manifestations, diagnostic evaluation, and management of AKI in a child with nephrotic syndrome accompanied by nephritic features. A 12-year-old girl presented with a 10-day history of fever, accompanied by swelling of the face, lower extremities, and genitalia, abdominal distension and pain, joint pain, oliguria, and reddish, foamy urine. Physical examination revealed stage 2 hypertension, periorbital edema, bilateral lower-extremity edema, labia majora edema, ascites, and anemic conjunctivae. Laboratory findings demonstrated anemia, hypoalbuminemia, elevated blood urea and serum creatinine levels, hyperkalemia, hypocalcemia, and partially compensated metabolic acidosis. Reduced glomerular filtration rate and oliguria supported the diagnosis of stage 2 AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The patient was diagnosed with AKI secondary to nephrotic syndrome with nephritic components and received comprehensive treatment consisting of intravenous fluid therapy, furosemide, captopril, prednisone, antibiotics, and supportive management. Comprehensive treatment and close monitoring were required to improve the patient's clinical condition, prevent complications, and preserve quality of life. This case highlights the importance of early recognition and multidisciplinary management of pediatric AKI associated with nephrotic syndrome and nephritic components to prevent progressive renal impairment.

Dampak Paparan Asap Rokok (Secondhand Smoke) terhadap Kejadian Bronkopneumonia pada Balita: Sebuah Laporan Kasus Ahmad Fathin Al Farisi; Shinta Nareswari
Medula Vol 17 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i1.1985

Bronchopneumonia is a lower respiratory tract infection that remains a major cause of morbidity and mortality among children, particularly toddlers. Exposure to environmental tobacco smoke has been recognized as an important risk factor that increases children's susceptibility to respiratory infections. This case report aims to describe the impact of secondhand smoke exposure on the occurrence of bronchopneumonia in a toddler. A 1.5-year-old boy presented with a six-day history of productive cough with thick green sputum, shortness of breath, and fever. The diagnosis was established based on medical history, physical examination such as takipneu and subcostal retraction, laboratory investigations, and chest radiography, which revealed bilateral patchy perihilar infiltrates. Exposure to cigarette smoke from his father, an active smoker, was identified as the primary risk factor. Management consisted of intravenous Ringer’s lactate fluid therapy, intravenous ampicillin, and oral paracetamol. After five days of treatment, the patient demonstrated significant clinical improvement and was discharged for outpatient follow-up. Secondhand smoke exposure is thought to contribute to the pathogenesis of bronchopneumonia by impairing mucociliary clearance, increasing mucus production, and suppressing local immune responses, thereby facilitating bacterial colonization of the lower respiratory tract. This case highlights that the harmful effects of cigarette smoke exposure may outweigh the protective benefits of good nutritional status, exclusive breastfeeding, and complete immunization. Therefore, education regarding the dangers of secondhand smoke exposure and smoking cessation within the household is essential for preventing recurrent bronchopneumonia in children.

Amenore Sekunder pada Remaja dengan Penyakit Ginjal Kronik yang Menjalani Hemodialisis: Laporan Kasus Muhamad Zaidan Algifari; Shinta Nareswari
Medula Vol 17 No 1 (2026): Medula
Publisher : CV. Jasa Sukses Abadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53089/medula.v17i1.1990

Secondary amenorrhea is a reproductive disorder frequently found in female patients with advanced chronic kidney disease (CKD). This condition may be influenced by hormonal dysfunction, malnutrition, anemia, and hemodialysis therapy. We report a 14-year-old female adolescent with stage V CKD who has undergone regular hemodialysis since August 2024 and has experienced secondary amenorrhea for 3 months. She experienced menarche at age 12 and previously had regular menstrual cycles. Physical examination revealed malnutrition (weight 30 kg, height 150 cm). Laboratory examination showed severe anemia with a hemoglobin level of 5.8 g/dL, accompanied by electrolyte disturbances including hyponatremia, hypokalemia, and hypercalcemia. The patient was diagnosed with secondary amenorrhea, stage V CKD, hemodialysis treatment, renal anemia, multiple electrolyte disturbances, and malnutrition. The pathophysiology of amenorrhea in this case is thought to involve a complex interaction between hypothalamic-pituitary-gonadal axis dysfunction induced by uremia, hyperprolactinemia, malnutrition, severe anemia, and the inability of hemodialysis to fully correct neuroendocrine disorders. This case demonstrates the importance of evaluating menstrual disorders in adolescents with advanced CKD. A multidisciplinary approach that includes optimizing dialysis adequacy, improving nutritional status, correcting anemia, and hormonal monitoring is necessary to support reproductive function and improve the patient's quality of life.

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