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All Journal Paediatrica Indonesiana
Neldy, Fahreza Aditya
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Health Professions Medicine & Pharmacology

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Scrofuloderma in a 1-year-old girl with severe malnutrition: a case report Jasin, Madeleine Ramdhani; Neldy, Fahreza Aditya; Setyanto, Darmawan Budi; Nugroho, Gufron; Sunhaji, Valerie; Ham, Maria Francisca
Paediatrica Indonesiana Vol. 63 No. 6 (2023): November 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.6.2023.511-6

Abstract

Tuberculosis (TB) remains a global burden and a leading cause of mortality due to infectious diseases worldwide. In 2020, 845,000 new TB cases (312 per 100,000 population) were diagnosed, with 96,000 deaths, including 4,700 deaths of TB with HIV. Tuberculosis typically affects the lungs, but it can also affect other organs, a condition termed extrapulmonary TB. In 2020, 16% of all TB cases had extrapulmonary manifestations.1 The first case of TB affecting the skin was reported in 1826.2,3 There are many types of cutaneous TB; one of the most common is scrofuloderma, more often found in children and young adults.4 Scrofuloderma starts with a lesion in a lymph node, bone, muscle, or tendon that spreads to the skin.5 The lesion progresses very slowly and is usually not painful. Therefore, many patients wait to seek treatment until an advanced stage, leading to poor prognosis.3 In this report, we present a case of a severely malnourished one-year-old girl with scrofuloderma.
Performance of WHO mid-upper arm circumference cut-off to diagnose severe acute malnutrition in under-fives Neldy, Fahreza Aditya; Yuliarti, Klara; Andriastuti, Murti
Paediatrica Indonesiana Vol. 64 No. 5 (2024): September 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.5.2024.439-46

Abstract

Background Many studies indicate that the current WHO recommendation of cut-off value mid-upper arm circumference (MUAC) is not sensitive to detect severe acute malnutrition (SAM) in under-fives cases. Various new cut-off values have been proposed with better diagnostic values but have a wide interval, 12.1 cm—14.5 cm, which may be due to different races or habitus. Objective To evaluate the diagnostic value of MUAC in diagnosing SAM compared to the weight for height Z score (WFZ) index, to evaluate sensitivity, specificity, positive and negative predictive value of MUAC with 11.5 cm as standard cut-off, and to find an alternative cut-off value that may offer better diagnostic performance. Methods We collected 421 subjects consecutively in January-February 2020 in Cipto Mangunkusumo Hospital and Puskesmas Cengkareng. We performed brief conversations for demographic data and did the measurement of physical examination and anthropometric measurement by trained researchers and research assistants. Results Mid-upper arm circumference has excellent diagnostic value to assess SAM in under-fives with area under curve 0,939 (CI95% 0,903-0,974). Diagnostic values MUAC using cut off 11.5 cm were 21% sensitivity (Se) 21%, 99.7% spesificity (Sp)and Youden Index (YI) of 0.20. By using 13.3 cm as a new cut-off value, MUAC has Se 89%, Sp 87%, and YI of 0.76. Conclusion We conclude that WHO MUAC cut-off using 11.5 cm has lower performance to detect SAM cases than the proposed new cut-off value of 13.3 cm. New MUAC cut-off should be considered to detect more SAM cases among under-fives.
Co-Authors Ham, Maria Francisca Jasin, Madeleine Ramdhani Murti Andriastuti, Murti Nugroho, Gufron Setyanto, Darmawan Budi Sunhaji, Valerie Yuliarti, Klara