Background Thalassemia major is a chronic disease requiring lifetime treatment. A recent study showed that 11-62% of thalassemia patients developed depression, which is associated with high morbidity and mortality. Understanding the extent of the problem related to depression and its contributing factors is important for early management. Objective To determine the prevalence and contributing factors for depression in children with thalassemia major. Methods This cross-sectional observational analytic study included thalassemia major patients aged 7 to <18 years in the Department of Child Health, Dr. Moh. Hoesin General Hospital (RSMH) in Palembang from June to July 2018 and had received blood transfusions at least 3 times. Subjects completed the Children’s Depression Inventory (CDI) questionnaire. Depression was defined as a total score > 13. Data were analyzed using SPSS for Windows ver. 22.0. Results There were 64 patients included in this study, with mean age 12 (SD 3) years and 82.8% female. Most subjects came from families with low socio-economic status and low parental education. Deferiprone was the most commonly used type of iron-chelating agent. Depression was detected in 34.4% of respondents. Multivariate analysis revealed that factors affecting depression in children with thalassemia major were low maternal education (OR 4.014; 95%CI 1.066 to 15.112) and use of deferasirox (OR 4.129; 95%CI 1.168 to 14.601). Conclusion Prevalence of depression in children with thalassemia major is 34.4%. Low maternal education and deferasirox use as an iron-chelating agent are associated with depression in children with thalassemia major.

Background. One of the negative impacts of electronic media use is the occurrence of sleep disturbances. Due to the COVID-19 pandemic, the use of electronic media in families, including in adolescents, has been increasing. Objective. This study was aimed at describing the association between electronic media use and sleep disturbances in adolescents in Palembang. Methods. A cross-sectional study was conducted in January to February 2021. Participants were 14–17-year-old high school students who completed a questionnaire to assess electronic media use and a Sleep Disturbance Scale for Children (SDSC) questionnaire to assess sleep disturbances. Results. One hundred and fifty-seven participants enrolled in this study. The majority of the participants were 16 years old or older (56.7%) and used smartphones (93%) with a median of media use of 10 hours a day. None of the participants’ characteristic variables showed statistically significant correlations. Similarly, none of the electronic media use variables showed statistically significant correlations. Conclusion. Most of adolescents in this study have used electronic media for more than 6 years, with median use of 10 hours per day, for noneducative purposes. Despite findings that most of them experience sleep disturbances, there was no statistically significant association between electronic media use and sleep disturbances in adolescents.

Background With advances in supportive and risk-stratified therapy, the 5-year survival rate of acute lymphoblastic leukemia has reached 85.5%. The ALL-2006 treatment protocol was modified and renamed the ALL-2013 protocol, with dose and duration changes. Objective To compare outcomes of the ALL-2006 and ALL-2013 protocols, with regards to mortality, remission, relapse, and three-year survival rates. Methods This was retrospective cohort study. Subjects were acute lymphoblastic leukemia (ALL) patients treated from 2011 to 2018 in Mohamad Hoesin Hospital, Palembang, South Sumatera. The three-year survival rates, relapse, remission rates and comparison of ALL-2006 and ALL-2013 protocols were analyzed with Kaplan-Meier method. Results Mortality was significantly correlated with age at diagnosis <1 year and >10 years, hyperleukocytosis, and high-risk disease status. Patients aged 1 to 10 years, with leukocyte count <50,000/mm3 and standard-risk status had significantly higher likelihood of achieving remission. Mortality was not significantly different between the ALL-2006 protocol group [70.6%; mean survival 1,182.15 (SD 176.89) days] and the ALL-2013 protocol group [72.1%; mean survival 764.23 (SD 63.49) days]; (P=0.209). Remission was achieved in 39.2% of the ALL-2006 group and 33% of the ALL-2013 group (P>0.05). Relapse was also not significantly different between the two groups (ALL-2006: 29.4% vs. ALL-2013: 17.9%; P>0.05). Probability of death in the ALL-2006 group was 0.3 times lower than in the ALL-2013 group (P<0.05), while that of the high-risk group was 3 times higher. Remission was 2.19 times higher in those with leukocyte <50,000/mm3 compared to those with hyperleukocytosis. In addition, relapse was significantly more likely in high-risk patients (HR 2.96; 95%CI 1.22 to 7.19). Overall, the 3-year survival rate was 33%, with 41.7% in the ALL-2006 group and 30.7% in the ALL-2013 group. Conclusion Three-year survival rate of ALL-2006 protocol is higher than that of ALL-2013 protocol but is not statistically significant.  Age at diagnosis <1 year and >10 years, hyperleukocytosis, and high-risk group are significantly correlated with higher mortality and lower remission rates. However, these three factors are not significantly different in terms of relapse.

Background. Acute transverse myelitis (ATM) in children can be secondary to central nervous system infections. Several reports have associated ATM with Epstein-Barr virus (EBV) infection. Case presentation. We report a previously healthy 10-year-old boy with paraparesis that started 7 days before admission. Spinal T2W MRI revealed extensive hyperintense lesions. Cerebrospinal fluid WBC was 268/µL and PCR examination was positive for EBV. High dose methylprednisolone (1 g/kg) was given for 5 days, the child was symptom free 3 months after presentation. Conclusion. Epstein-Barr infection should be considered in ATM, particularly when CSF WBC count is high.

Background. The drugs that are often given to children with GERD are stomach acidsuppressants, namely the H2 receptor antagonist and proton pump inhibitor (PPI) classof drugs, but the effectiveness of the two drugs is still controversial. Objective. Toevaluate the use of PPIs and H2 RA in children with GERD through evidence-basedcase studies. Methods. Systematic search for literature using the search instrumentPUBMED, Cochrane, Google Scholar, Pediatrica Indonesiana, and Sari Pediatri.Searches included systematic review articles, randomized controlled clinical trials andcohort studies. Abstract only studies, non-clinical evaluation results, and case reportswere excluded. Results. The study was obtained from three RCT studies comparingthe effectiveness of omeprazole and ranitidine in the treatment of GERD, all of whichhave differences. Azizollahi et al demonstrated that after 2 weeks of standard doses ofomeprazole or ranitidine there was a comparable significant improvement. Ummarinoet al demonstrated that omeprazole was significantly better than high-dose ranitidine.Cucchiara et al (1993) showed that high doses of ranitidine were as good as omeprazole.Another study by Pfefferkorn et al showed no significant effect on the addition ofomeprazole therapy combined with ranitidine in preventing the incidence of NAB. Astudy by Boccia et al comparing omeprazole, ranitidine, and non-therapy, found verylow relapse rates. Conclusion. Evidence regarding the use of ranitidine versusomeprazole in infants and children is lacking. Based on one study specifically in theinfant age group, omeprazole and ranitidine were of comparable effectiveness. A higherdose of ranitidine may have a better effect. In terms of complete symptom relief,omeprazole is likely to be superior to ranitidine.