Correlation of histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) to the platelet count in patient with dengue viral infection

Thrombocytopenia is often associated with clinically worse outcomes in dengue viral infection (DVI) patients. Histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) have been reported to induce thrombocytopenia. These drugs are administered to DVI patients due to misinterpretation of abdominal pain. The study aimed to evaluate the correlation between H2RA and PPI administration with thrombocytopenia event on hospitalized DVI patients. An analytical retrospective cross-sectional study was conducted using medical records of the patient admitted by final diagnosed DVI in seven major hospital in Bandung from January 1st to December 31st, 2015. Patients were separated into two groups i.e. with and without H2RA and PPI. Pearson point biserial analysis was then applied to evaluate the correlation of each drug administration to platelet count of DVI.  A total of 4005 patients with final diagnosed DVI involved in this study. About 11.0% and 25.1% of the patients received H2RA and PPI, respectively. Mostly the DVI patients receiving H2RA (55%) and PPI (50.8%) showed the platelet count <50.000/mm3. A very weak positive correlation between the administration of H2RA (p <0.001; r=0.103) and PPI (p <0.001; r=0.138) with the low platelet count of the patients was observed. In conclusion, the administration of H2RA and PPI is correlated to the low platelet count in DVI patients. Although the correlation is weak, H2RA and PPI should be administered with caution due to its thrombocytopenia side effect

Knowledge of Helminthiasis of People Living in Slum Areas of Bandung District, Indonesia

Among the most prevalent infections worldwide, Soil-Transmitted Helminth (STH) infection is the one that affects the poorest and most deprived populations. Data from the WHO shows that more than 1.5 billion people are affected by soil-transmitted helminth diseases globally. In 2010, it was estimated that 819.0 million, 464.6 million, and 438.9 million people around the world were infected with Ascaris lumbricoides, Trichuris trichiura, and hookworms (Ancylostoma duodenale and Necator americanus), respectively, with the Southeast Asia as the region with the highest prevalence of STH. Children’s awareness and knowledge of helminthiasis are essential to reduce the STH infection prevalence. Unfortunately, evaluation on children’s understanding of helminthiasis is still scarce. This study was intended to measure children's knowledge of STH infections and its prevention, especially prevention measures at home, in Bandung District, Indonesia. This study was conducted in March 2021 on 506 children who lived in 15 different subdistricts in Bandung District. Data were collected through a questionnaire that was used for face-to-face interviews with the children. All data were recorded in RedCap apps for further analysis. It was demonstrated in this study that children in Bandung District generally have low-to-medium knowledge on helminthiasis prevention, symptoms, and treatment (85%). Thus, there is an urgent need for an education program on helminthiasis to complement the deworming measures conducted by the local government

Correlation of Thrombocytopenia and Length of Hospitalization in Dengue Child Patient

Dengue virus infection (DVI) is one of the major health problems that cause 500 thousand patients hospitalized annually. Thrombocytopenia is one of the abnormal hematologic findings that is always found in DVI patients. This study aimed to determine the correlation of thrombocytopenia and length of hospitalization in dengue child patients. This retrospective analysis study used secondary data from seven major hospitals in Bandung with a total sampling method. The inclusion criteria were patients aged 0–18 years old diagnosed with dengue fever (DF), or dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS) who was admitted from January to December 2015 and excluded when there was comorbid as well as incomplete data. The correlation was analyzed by Spearman’s rank correlation test. There were 2,025 samples from a total of 5,712 DVI cases during 2015. Among those who admitted, most of the patients experienced severe thrombocytopenia (40%) with the average length of hospitalization was 4.84 days. This result was not much different from the patients with moderate (38.1%) and mild (21.9%) thrombocytopenia who were treated for an average of 4.13 days and 4.08 days, respectively. The analysis of correlation obtained a significant relationship between thrombocytopenia and length of hospitalization despite showing a weak correlation (r=0.231, p=0.001). In conclusion, there is a weak correlation between thrombocytopenia and length of hospitalization among dengue child patients.   KORELASI TROMBOSITOPENIA DENGAN LAMA RAWAT INAP PADA PASIEN ANAK TERINFEKSI VIRUS DENGUE Infeksi virus dengue (IVD) merupakan salah satu masalah kesehatan utama yang menyebabkan 500 ribu pasien dirawat di rumah sakit setiap tahun. Trombositopenia adalah salah satu temuan abnormal hematologi yang selalu ditemukan pada pasien IVD. Penelitian ini bertujuan mengetahui korelasi trombositopenia dengan lama rawat inap pada pasien anak terinfeksi virus dengue. Penelitian analitik retrospektif ini menggunakan data sekunder tujuh rumah sakit besar di Kota Bandung dengan metode total sampling. Kriteria inklusi adalah pasien anak usia 0–18 tahun yang didiagnosis demam dengue (DD), atau demam berdarah dengue (DBD), atau sindrom syok dengue (SSD) yang dirawat dari bulan Januari hingga Desember 2015. Kriteria eksklusi meliputi komorbiditas dan data rekam medis yang tidak lengkap. Analisis dilakukan dengan uji korelasi rank Spearman. Terdapat 2.025 sampel dari total 5.712 kasus IVD selama tahun 2015. Di antara yang dirawat, sebagian besar pasien mengalami trombositopenia berat (40%) dengan lama rawat inap rerata 4,84 hari. Hasil ini tidak jauh berbeda dengan pasien dengan trombositopenia sedang (38,1%) dan ringan (21,9%) yang dirawat selama rerata 4,13 hari dan 4,08 hari masing-masing. Analisis korelasi diperoleh hubungan yang bermakna antara trombositopenia dan lama rawat inap meskipun dengan nilai korelasi lemah (r=0,231; p=0,001). Simpulan, terdapat korelasi lemah antara trombositopenia dan lama rawat inap pada pasien anak terinfeksi virus dengue

Diagnostic Value of Coproantigen for Detection of Giardia Infection in Stunted Children

Background: Giardiasis is a protozoa infection caused by Giardia intestinalis, which commonly infects children, impairing children’s growth, development, and cognitive function. Standard diagnosis is carried out by microscopic examination of stool. This study aimed to evaluate coproantigen examination in stunted children compared to microscopic examination. Methods: A cross-sectional study was performed on stools collected from a survey among stunted children in Bandung in 2019. Stools were preserved in 10% formaldehyde and kept at -20oC until used. Direct microscopy examination with 2% lugol solution and coproantigen ELISA test using Giardia Cryptosporidium (combo test) coproantigen test kit were performed in Parasitology Laboratory Faculty of Medicine, Universitas Indonesia. Result: A total of 99 stools originated from stunted children aged 2-6 years. with boys predominant (52.5%). Microscopic examination showed that 12.1% (12/99) of the children were harboring intestinal parasites, such as the protozoa Giardia intestinalis, Blastocystis spp, and Entamoeba coli (E. coli). Giardia was the primary infection (9.1%), of which single Giardia infection (n = 8) and mixed infection of Giardia and Blastocystis spp (n = 1).  Interestingly, coproantigen examination resulted in 6 positive samples, and 4 samples agreed with the microscopy result. With a sensitivity of 44.4% and a specificity of 97.7%. The positive and negative predictive values were 66.7% and 94.7%, respectively. Conclusion: A moderate prevalence of Giardia in stunted children in Bandung regency has been observed. The combo coproantigen test method has high specificity and is suitable for use as a confirmation test to exclude Giardia infection

The inappropriate use of antibiotics in hospitalized dengue virus-infected children with presumed concurrent bacterial infection in teaching and private hospitals in Bandung, Indonesia.

BackgroundDengue virus infection (DVI) among children is a leading cause of hospitalization in endemic areas. Hospitalized patients are at risk of receiving unnecessary antibiotics.MethodsA retrospective medical review analysis study was conducted to evaluate the prevalence, indication, and choice of antibiotics given to hospitalized patients less than 15 years of age with DVI in two different hospital settings (teaching and private hospitals) in the Municipality of Bandung. Epidemiological, clinical, and laboratory data were obtained using a pre-tested standardized questionnaire from patients' medical records admitted from January 1 to December 31, 2015.ResultsThere were 537 (17.5%) out of 3078 cases who received antibiotics. Among 176 cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in 1 (0.6%) case and 6 (0.3%) cases. In private hospitals among 2902 cases, presumed bacterial URTI was found in 324 (11.2%) cases, typhoid fever in 188 (6.5%) cases and urinary tract infection (UTI) in 18 (0.6%) cases. The prevalence of URTI and typhoid fever were significantly lower in the teaching hospitals compared to the private hospitals (pConclusionThe use of antibiotics in private hospitals was inappropriate in most cases while the use of antibiotics in the teaching hospital was more accountable. This study indicated that interventions, such as the implementation of the antibiotics stewardship program, are needed especially in private hospitals to reduce inappropriate use of antibiotics

Liver Function Profile of Pediatric Patients with Dengue Viral Infection Admitted to a Tertiary Referral Hospital during the COVID-19 Pandemic

Background: Dengue infection is endemic in more than 100 countries; 70% of cases occur in Asia. One of dengue infection complication is hepatic dysfunction. The COVID-19 pandemic may cause a delay in seeking treatment and affect severe case of dengue infection when admitted to the hospital. This study aimed to analyze the liver function profile in dengue pediatric patients during the COVID-19 pandemic.Methods: All patients under 18 with confirmed dengue serology (NS-1 immunochromatography or IgM anti-Dengue (ELISA) test and IgG anti-Dengue (ELISA) test) in Dr. Hasan Sadikin General Hospital from 2021–2022 were included in this retrospective study. The patients were categorized based on the modified WHO classification of 2009. Data were processed with SPSS® ver. 25 and analyzed using Chi-Square and One Way-ANOVA.Result: In total, 85 patients were tested for the liver function; most severe dengue patients had abnormal SGOT and SGPT levels (100% vs. 64%).  The SGOT and SGPT levels during the initial admission were higher in the severe dengue group (634 U/l and 271 U/l) and significantly different among groups (p=0.001 and p=0.032). The elevated SGOT (1,339 U/l vs. 203 U/l vs. 87.3 U/l; p=0.014) and SGPT (438 U/l vs. 100 U/l vs. 42.8 U/l; p=0.005) levels were higher in the severe dengue group.Conclusion: The severity of dengue is in line with the increase in SGOT and SGPT levels. During the COVID-19 pandemic, the liver dysfunction persists and may be interfered with by delays in dengue treatment. Early recognition and prompt treatment are needed to decrease morbidity and mortality

Liver Function Profile of Pediatric Patients with Dengue Viral Infection Admitted to a Tertiary Referral Hospital during the COVID-19 Pandemic

Background: Dengue infection is endemic in more than 100 countries; 70% of cases occur in Asia. One of dengue infection complication is hepatic dysfunction. The COVID-19 pandemic may cause a delay in seeking treatment and affect severe case of dengue infection when admitted to the hospital. This study aimed to analyze the liver function profile in dengue pediatric patients during the COVID-19 pandemic. Methods: All patients under 18 with confirmed dengue serology (NS-1 immunochromatography or IgM anti-Dengue (ELISA) test and IgG anti-Dengue (ELISA) test) in Dr. Hasan Sadikin General Hospital from 2021–2022 were included in this retrospective study. The patients were categorized based on the modified WHO classification of 2009. Data were processed with SPSS® ver. 25 and analyzed using Chi-Square and One Way-ANOVA. Result: In total, 85 patients were tested for the liver function; most severe dengue patients had abnormal SGOT and SGPT levels (100% vs. 64%).  The SGOT and SGPT levels during the initial admission were higher in the severe dengue group (634 U/l and 271 U/l) and significantly different among groups (p=0.001 and p=0.032). The elevated SGOT (1,339 U/l vs. 203 U/l vs. 87.3 U/l; p=0.014) and SGPT (438 U/l vs. 100 U/l vs. 42.8 U/l; p=0.005) levels were higher in the severe dengue group. Conclusion: The severity of dengue is in line with the increase in SGOT and SGPT levels. During the COVID-19 pandemic, the liver dysfunction persists and may be interfered with by delays in dengue treatment. Early recognition and prompt treatment are needed to decrease morbidity and mortality

Surveillance of Soil-Transmitted Helminth Infection in Preschool Child Population: Do Changes in Behavior and Immunological Responses Affect Prevalence?

Soil-transmitted helminths (STHs) persist as a significant global public health issue among neglected tropical diseases (NTDs), particularly in children. STH infection can induce immune responses that affect the course of the disease; if treatment fails, chronic infection can lead to stunting, especially among children aged 24–59 months, which is a vulnerable period for growth and development. We conducted a correlational, cross-sectional data collection study to evaluate the characteristics and association of 25(OH)D, interleukin-5 (IL-5), and interleukin-13 (IL-13) with the prevalence of STH infection in children aged 24–59 months in Bandung District, Indonesia, in October 2019–January 2023. We recruited 694 subjects (401 stunted and 293 normal-height children). The prevalence of STH infection among the stunted and normal-height groups was 5.7% (95% CI: 3.85–8.46%) and 3.4% (95% CI; 1.86–6.17%) (p = 0.156), respectively. The probability of the prevalence of STH infection in children with levels of 25(OH)D, IL-5, and IL-13 below the cut-off point was 6,93 to 16.71 times higher. We found a relationship between IL-5, IL-13, and environmental factors and the prevalence of STH infection in stunted children

Diagnostic Value of Coproantigen for Detection of Giardia Infection in Stunted Children

Background: Giardiasis is a protozoa infection caused by Giardia intestinalis, which commonly infects children, impairing children’s growth, development, and cognitive function. Standard diagnosis is carried out by microscopic examination of stool. This study aimed to evaluate coproantigen examination in stunted children compared to microscopic examination.Methods: A cross-sectional study was performed on stools collected from a survey among stunted children in Bandung in 2019. Stools were preserved in 10% formaldehyde and kept at -20oC until used. Direct microscopy examination with 2% lugol solution and coproantigen ELISA test using Giardia Cryptosporidium (combo test) coproantigen test kit were performed in Parasitology Laboratory Faculty of Medicine, Universitas Indonesia.Result: A total of 99 stools originated from stunted children aged 2-6 years. with boys predominant (52.5%). Microscopic examination showed that 12.1% (12/99) of the children were harboring intestinal parasites, such as the protozoa Giardia intestinalis, Blastocystis spp, and Entamoeba coli (E. coli). Giardia was the primary infection (9.1%), of which single Giardia infection (n = 8) and mixed infection of Giardia and Blastocystis spp (n = 1).  Interestingly, coproantigen examination resulted in 6 positive samples, and 4 samples agreed with the microscopy result. With a sensitivity of 44.4% and a specificity of 97.7%. The positive and negative predictive values were 66.7% and 94.7%, respectively.Conclusion: A moderate prevalence of Giardia in stunted children in Bandung regency has been observed. The combo coproantigen test method has high specificity and is suitable for use as a confirmation test to exclude Giardia infection

Answers to common questions about COVID-19 vaccines in children with cancer

Background: The SARS-CoV-2 outbreak in 2020 evolved into a global pandemic, and COVID-19 vaccines became rapidly available, including for pediatric patients. However, questions emerged that challenged vaccine acceptance and use. We aimed to answer these questions and give recommendations applicable for use in pediatric patients with cancer by healthcare professionals and the public. Methods: A 12-member global COVID-19 Vaccine in Pediatric Oncology Working Group made up of physicians and nurses from all world regions met weekly from March to July 2021. We used a modified Delphi method to select the top questions. The Working Group, in four-member subgroups, answered assigned questions by providing brief recommendations, followed by a discussion of the rationale for each answer. All Working Group members voted on each recommendation using a scale of 1 to 10, 10 being complete agreement. A “pass” recommendation corresponded to an agreement ≥7.5. Results: We selected 15 questions from 173 suggested questions. Based on existing published information, we generated answers for each question as recommendations. The overall average agreement for the 24 recommendations was 9.5 (95% CI 9.4–9.6). Conclusion: Top COVID-19 vaccine-related questions could be answered using available information. Reports on COVID-19 vaccination and related topics have been published at record speed, aided by available technology and the priority imposed by the pandemic; however, all efforts were made to incorporate emerging information throughout our project. Recommendations will be periodically updated on a dedicated website