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A pediatric case and literature review of mucormycosis: Diagnostic and treatment challenges in a resource poor setting Lubis, Inke ND.; Farah, Sara; Pasaribu, Ayodhia P.; Evalina, Rita; Daulay, Rini S.; Wijaya, Hendri
Narra J Vol. 3 No. 3 (2023): December 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i3.426

Mucormycosis is an emerging disease that primarily affects immunocompromised patients; however, it has also been reported in immunocompetent individuals. Studies in the pediatric population are limited and reported mostly in case studies or series. The aim of this case report is to present a pediatric mucormycosis originated from Sumatra Island, Indonesia. A 13-year-old boy was referred to a tertiary hospital with facial necrosis involving the nasal, oral, and left maxillary areas, as well as left periorbital edema. No known underlying conditions were documented. The diagnosis was confirmed by histopathological findings of broad, pauci-septate, ribbon-like hyphae branching at 90°. The patient was managed by a multidisciplinary team consisting of the ear, nose, and throat, infectious diseases, dermatology, surgery, microbiology, and pathology departments. Management of the patient included debridement of the necrotic lesion and antibiotics and anti-fungal (fluconazole). Due to unavailability, the patient was not treated with amphotericin B. The patient died after 30 days of admission. This case highlights the importance of maintaining a high suspicion of invasive mucormycosis, even in immunocompetent children, when symptoms and signs are present, especially in resource-limited settings.

Norwegian scabies in human immunodeficiency virus and tuberculosis-infected child: A case report Wijaya, Hendri; Kollins, Fini; Lubis, Inke ND.; Pasaribu, Ayodhia P.; Evalina, Rita; Nababan, Kristo A.; Paramita, Deryne A.
Narra J Vol. 4 No. 1 (2024): April 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i1.661

Norwegian scabies is a rare scabies with the manifestation of thick crusts of the extremities of the skin that contain eggs and mites. Several conditions in which scabies infection is easily transmitted include immunocompromised, home nursing, and severe neurological disorder. The aim of this case report was to present a thorough analysis of a comprehensive resource for the management of Norwegian scabies patients, with a specific focus on individuals who also have HIV or other immunocompromising diseases. A 1-year-and-7-month-old boy was presented to the hospital with a chief complaint of a thick crust that he had experienced for four months. It began as a red papule in the lower extremity, then crusted and spread to the whole body. The patient kept scratching due to itching, had a recurrent fever and diarrhea for three months, and cough for one month. The patient was diagnosed with human immunodeficiency virus (HIV) and pulmonary tuberculosis at three months, suspected to get the infection from the parents. Sarcoptes scabiei was found from microscopy examination of skin scraping. The patient received holistic treatment, including antiretroviral drugs, antituberculosis medication, scabies treatment, and malnutrition treatment. Appropriate scabies treatment aimed at peeling crusted skin, relieving itching, and increasing the patient ability to use the extremities. Comorbidity conditions caused by HIV and pulmonary tuberculosis should also be treated to optimize the outcome. The patient was discharged in good condition with sanitation education and regular follow-up at the outpatient clinic. This case highlights that Sarcoptes scabiei infestation may be a clue to an immunocompromised condition. Holistic therapy aiming to cure underlying infection, infestation and underlying nutrition and psychosocial problems must be addressed to fully cure this high-burden case.

Determinants of mortality in relationship between clinical and laboratory characteristics with the outcomes of children with diphtheria: A cross-sectional study at a national hospital of Sumatra region in 2020–2023 Dinanti, Shinta P.; Ramayani, Oke R.; Pasaribu, Ayodhia P.
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.776

In 2017, diphtheria outbreaks occurred in several provinces in Indonesia; however, the epidemiological data in the country is limited. The aim of this study was to determine the association between clinical findings and laboratory parameters associated with mortality of children with diphtheria. A retrospective cohort study was conducted at Haji Adam Malik General Hospital, Medan, Indonesia, covering diphtheria patients from January 2020 to December 2023. All patients aged 1–18 years clinically diagnosed with diphtheria were considered eligible. The associations between demographic characteristics, clinical features, immunization status, complications, and laboratory profiles with mortality were determined using Fisher's exact test, and the odds ratio (OR) with a 95% confidence interval (95%CI) was calculated. Our data indicated that the clinical characteristics of myocarditis (p=0.005) and airway obstruction (p=0.003) were associated with mortality. There was also a significant association between thrombocytopenia (p=0.020) and mortality in diphtheria patients. Patients with airway obstruction were 13 times more likely to have an increase in mortality compared to patients without airway obstruction. This study highlights that clinical and laboratory characteristics could be associated with in-hospital mortality of diphtheria cases, and therefore, pediatricians should be aware of the presence of those characteristics to prevent the mortality of the patients.

Determinants of COVID-19 severity and mortality in children: A retrospective and multicenter cohort study in Medan, Indonesia Airlangga, Eka; Wahyuni, Arlinda S.; Siregar, Jelita; Malisie, Ririe F.; Lubis, Bugis M.; Adisasmito, Wiku B.; Zarlis, Muhammad; Pasaribu, Ayodhia P.
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.865

This study investigated indicators of the severity and mortality of COVID-19 in children in Medan, Sumatera Utara Province, Indonesia. The aim of this study was to identify determinants of severity and outcome of children with COVID-19 as the lesson learned from the COVID-19 pandemic, particularly the limited health facilities in Indonesia. This retrospective cohort study was conducted in 2020, 2021, and 2022 at multiple centers. Inpatient and outpatient children confirmed to be SARS-CoV-2 positive were randomly recruited in the selected hospitals. Baseline data (demographic, clinical, laboratory and radiological data) were collected, and outcomes were classified as recovered/deceased (for the inpatient group) or returned to the hospital (for the outpatient group). Severity status was identified based on the Indonesia COVID-19 guidelines. The laboratory data were categorized according to international standards, and data were analyzed using univariate analyzes followed by multivariate logistic regression. A total of 303 inpatient and 114 outpatient children were included in the analysis. Out of the total inpatient cases, 11 patients died with 3.6 mortality rate. Our final multivariate indicated that the presence of shortness of breath (SOB), anemia, and abnormal C-reactive protein (CRP) levels were significantly associated with the severity or the presence of emergency signs, while the presence of SOB and comorbidities were significantly associated with mortality in inpatient children with COVID-19. The presence of fever, cough, SOB, muscle ache and diarrhea were the reasons why the children were returned to the hospital from self-isolation at home among outpatient COVID-19 cases; however, the cough was the only significant factor in the final multivariate mode. This study highlights important determinants of COVID-19 severity and mortality in children, which should be considered during clinical decision-making in low-resource settings of healthcare centers in Indonesia.

Factors associated with feeding problems in children with cerebral palsy: A cross-sectional study from Indonesia Maulidia, Dwi S.; Sembiring, Tiangsa; Dimyati, Yazid; Tanjung, Ika CD.; Wahyuni, Arlinda S.; Pratita, Winra; Nasution, Halida R.; Alharbi, Olayan; Pasaribu, Ayodhia P.
Narra X Vol. 2 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v2i3.163

Children with cerebral palsy are at high risk for feeding difficulties and malnutrition due to motor impairments and associated conditions. The aim of this study was to evaluate the prevalence and types of feeding problems and their association with malnutrition in children with cerebral palsy. A cross-sectional study was conducted involving 54 children under five years old with cerebral palsy. Participants were classified into spastic cerebral palsy subtypes such as quadriplegic, hemiplegic, diplegic, or triplegic. Feeding problems were categorized as inappropriate feeding practices, reduced food intake, parental misperception, and food preferences using the Pediatric Symptom Checklist-17. Nutritional status was assessed using weight-for-age percentiles based on WHO growth charts. History of constipation and dysphagia were also recorded. Data analysis included Chi-square and Mann-Whitney U tests. Among the participants, 38.9% had hemiplegia, 33.3% diplegia, and 25.9% quadriplegia. Feeding problems were prevalent, with inappropriate feeding practices being the most common (70.4%). Malnutrition was identified in 59.3% of the children. However, no significant associations were observed between CP subtype or demographic variables and the types of feeding problems. Similarly, the type of feeding problem was not significantly associated with malnutrition. Constipation and dysphagia were reported in 31.5% and 37.0% of participants, respectively, and were significantly associated with nutritional status (p<0.001). In conclusion, feeding problems and malnutrition are common in children with cerebral palsy, with inappropriate feeding practices being the most prevalent issue. Although no significant associations were found between CP subtypes or the types of feeding problems and malnutrition, the findings emphasize the multifactorial nature of feeding challenges.

Factors associated with feeding problems in children with cerebral palsy: A cross-sectional study from Indonesia Maulidia, Dwi S.; Sembiring, Tiangsa; Dimyati, Yazid; Tanjung, Ika CD.; Wahyuni, Arlinda S.; Pratita, Winra; Nasution, Halida R.; Alharbi, Olayan; Pasaribu, Ayodhia P.
Narra X Vol. 2 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v2i3.163

Children with cerebral palsy are at high risk for feeding difficulties and malnutrition due to motor impairments and associated conditions. The aim of this study was to evaluate the prevalence and types of feeding problems and their association with malnutrition in children with cerebral palsy. A cross-sectional study was conducted involving 54 children under five years old with cerebral palsy. Participants were classified into spastic cerebral palsy subtypes such as quadriplegic, hemiplegic, diplegic, or triplegic. Feeding problems were categorized as inappropriate feeding practices, reduced food intake, parental misperception, and food preferences using the Pediatric Symptom Checklist-17. Nutritional status was assessed using weight-for-age percentiles based on WHO growth charts. History of constipation and dysphagia were also recorded. Data analysis included Chi-square and Mann-Whitney U tests. Among the participants, 38.9% had hemiplegia, 33.3% diplegia, and 25.9% quadriplegia. Feeding problems were prevalent, with inappropriate feeding practices being the most common (70.4%). Malnutrition was identified in 59.3% of the children. However, no significant associations were observed between CP subtype or demographic variables and the types of feeding problems. Similarly, the type of feeding problem was not significantly associated with malnutrition. Constipation and dysphagia were reported in 31.5% and 37.0% of participants, respectively, and were significantly associated with nutritional status (p<0.001). In conclusion, feeding problems and malnutrition are common in children with cerebral palsy, with inappropriate feeding practices being the most prevalent issue. Although no significant associations were found between CP subtypes or the types of feeding problems and malnutrition, the findings emphasize the multifactorial nature of feeding challenges.

Ivermectin and dexamethasone combination induces apoptosis in SUP-B15 cell line Siregar, Olga R.; Wahyuni, Arlinda S.; Pasaribu, Ayodhia P.; Edianto, Deri; Ugrasena, I DG.; Amelia, Rina; Lubis, Inke ND.; Rusda, Muhammad
Narra J Vol. 5 No. 2 (2025): August 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i2.1975

The development of glucocorticoid resistance has complicated the management of acute lymphoblastic leukemia (ALL), leading to increased mortality rates. Ivermectin, a low-cost and well-established anthelmintic, exhibits anticancer potential and may enhance glucocorticoid toxicity in ALL, offering a possible strategy to overcome resistance. The aim of this study was to evaluate the apoptotic effect of combining ivermectin with dexamethasone in ALL. ALL SUP-B15 cells were cultured under standard conditions before treatment with dexamethasone (200 nM) alone or combined with ivermectin (5, 10, and 20 µM), with an untreated group serving as the control. Cytotoxicity was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay by measuring cell viability and inhibition. Apoptosis was evaluated through BAX, BCL-2, and CASP3 gene expression analysis using reverse transcription-polymerase chain reaction (RT-PCR). The findings revealed that the combination of ivermectin and dexamethasone was superior in the repression of ALL cell viability compared to control (p<0.001). The combination of dexamethasone 200 nM + ivermectin 20 μM demonstrated the most significant cell inhibition of 38.16±0.04% (p<0.001) and produced the lowest cell viability of 61.84±0.05% (p<0.001). Moreover, the combination of dexamethasone 200 nM + ivermectin 20 μM demonstrated superior upregulations of BAX (p<0.001) and CASP3 (p<0.001). In conclusion, the addition of ivermectin (5 µM) to dexamethasone regimen (200 nM) increases its cytotoxic and apoptotic activities against SUP-B15 cell line as observed by the CASP3 and BAX upregulation. Studies to confirm the enhanced anticancer activity by this combination by observing the protein levels and animal studies are warranted.

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