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All Journal Sari Pediatri Paediatrica Indonesiana World Nutrition Journal Narra J Archives of Pediatric Gastroenterology, Hepatology, and Nutrition The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Muzal Kadim
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Diare Persisten: Karakteristik Pasien, Klinis, Laboratorium, dan Penyakit Penyerta Deddy S Putra; Muzal Kadim; Pramita GD; Badriul Hegar; Aswitha Boediharso; Agus Firmansyah
Sari Pediatri Vol 10, No 2 (2008)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp10.2.2008.94-9

Abstract

Latar belakang. Diare persisten menjadi perhatian setelah WHO berhasil menurunkan kejadian diare akut dengan upaya rehidrasi oral. Sepuluh persen diare akut karena infeksi berlanjut menjadi diare persisten dengan angka kematian pada balita 35%.Tujuan. Mengetahui karakteristik pasien, manifestasi klinis, laboratorium, dan penyakit penyerta diare persistenMetode. Studi prospektif terhadap anak dengan diare persisten yang berobat di rumah sakit Dr. Cipto Mangunkusumo, Jakarta, sejak 1 Juni sampai 31 Agustus 2005. Data diperoleh dengan mengisi formulir kuesioner yang ditanyakan kepada ibu pasien dan catatan medis pasien saat pertama datang.Hasil. Didapatkan 41 anak menderita diare persisten, usia terbanyak di bawah 5 tahun. Pendidikan ibu terbanyak sekolah menengah atas (48,7%) dengan tingkat ekonomi rendah (80,5%). Sebagian besar anak telah mendapat antibiotik sebelumnya (48,2%). Demam ditemukan pada 63,4% anak, mual dan muntah 48,8%, dan tinja berlendir 53,7%. Penyakit penyerta, gizi buruk 36,6% anak, alergi susu sapi 31,7%, infeksi saluran kencing 24,4%, dan infeksi HIV 19,5%. Anemia dan hipoalbuminemia ditemukan beturut-turut pada 71,4% dan 64,7% anak.Kesimpulan. Diare persisten terutama mengenai balita dengan tingkat ekonomi keluarga dan pendidikan ibu rendah. Demam dan tinja berlendir merupakan manifestasi klinis yang paling sering dijumpai, sedangkan gizi buruk, alergi susu sapi, infeksi saluran kemih dan infeksi HIV merupakan penyakit yang paling sering menyertai diare persisten. Anemia dan hipoalbumineia merupakan kelainan laboratorium yang paling sering ditemukan.
Gambaran Kadar Natrium dan Kalium Plasma Berdasarkan Status Nutrisi Sebelum dan Sesudah Rehidrasi pada Kasus Diare yang Dirawat Di Departemen IKA RSCM Hasri Salwan; Agus Firmansyah; Aswitha Boediarso; Badriul Hegar; Muzal Kadim; Fatima Safira Alatas
Sari Pediatri Vol 9, No 6 (2008)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp9.6.2008.406-11

Abstract

Latar belakang. Pemberian cairan rehidrasi parenteral dapat mengatasi gangguan natrium (Na) dan kalium(K) plasma pada anak dengan diare. Status nutrisi dapat mempengaruhi perbaikan gangguan Na dan Kplasma saat rehidrasi. Respon perbaikan kadar Na dan K plasma pada anak diare dengan status nutrisikurang dan buruk (NKB) berbeda dengan anak status nutrisi baik (NB)Tujuan Menilai pengaruh status nutrisi terhadap kadar Na, K plasma, dan perubahannya pada saat dehidrasidan rehidrasi.Metode. Penelitian potong lintang retrospektif terhadap data sekunder pasien diare yang dirawat diDepartemen IKA RSCM dengan rehidrasi mengunakan cairan KAEN 3B. Kelompok penelitian dibagi menjadikelompok nutrisi baik (NB) dan kelompok nutrisi kurang dan buruk (NKB). Jumlah subjek penelitian 32pada setiap kelompok. Faktor perancu yaitu muntah, demam, terapi oralit, dan gambaran klinis diare.Hasil. Status nutrisi BB/TB kelompok NB 105,1±10,7 dan kelompok NKB 78,2±12,0, dengan nutrisi buruknya28,1%. Pada kelompok NB, kadar Na dehidrasi 135,4±8,17 meq/l, rehidrasi 138,6±6,73 meq/l, meningkat3,2±8,70 meq/l. Pada kelompok NKB, kadar Na dehidrasi 134,3±7,12 meq/l, rehidrasi 132,2±5,23 meq/l,menurun 1,8±6,14 meq/l. Pada kelompok NB, kadar K dehidrasi 3,6±0,86 meq/l, rehidrasi 3,9±0,81 meq/l,meningkat 0,36±0,90 meq/l. Pada kelompok NKB, kadar K dehidrasi 3,7± 0,82 meq/l, rehidrasi 3,9±0,70meq/l, meningkat 0,26±0,70 meq/l. Kesemuanya tidak berbeda bermakna (p>0,05) antara gizi baik atau kurang/buruk. Dari semua variabel perancu muntah (p=0,009) dan komplikasi (p=0,026) yang tersebar tidak merata.Kesimpulan. Tidak didapatkan perbedaan kadar Na dan K saat dehidrasi, rehidrasi, dan perubahannyapada kelompok NB dan NKB 
Efektivitas Pemberian Nutrisi Enteral Eksklusif terhadap Induksi Remisi Penyakit Crohn Muzal Kadim; Jennie Dianita Sutantio
Sari Pediatri Vol 21, No 1 (2019)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (261.811 KB) | DOI: 10.14238/sp21.1.2019.57-65

Abstract

Latar belakang. Pemberian nutrisi enteral eksklusif (NEE) direkomendasikan sebagai terapi lini pertama induksi remisi penyakit Chron pada anak. Namun, terdapat perbedaan aplikasi terapi di berbagai negara, termasuk Indonesia. Tujuan. Mengetahui efektivitas terapi NEE dibanding kortikosteroid untuk induksi remisi penyakit Crohn pada anak.Metode. Pencarian artikel dilakukan melalui basis data PubMed dan Cochrane dengan kata kunci yang sesuai. Seleksi dilakukan sesuai kriteria inklusi dan eksklusi. Telaah kritis dilakukan dengan evaluasi validity, importance, dan applicability. Hasil. Dua artikel berupa studi meta-analisis dan uji klinis acak terkontrol didapatkan dari hasil pencarian. Meta-analisis terhadap 3 studi menunjukkan tidak ada perbedaan bermakna kedua terapi terhadap induksi remisi (OR 1,31, IK 95% 0,68-2,53). Uji klinis acak terkontrol juga menunjukkan hal yang serupa (NEE 100% vs kortikosteroid 83%), tetapi didapatkan penyembuhan mukosa yang bermakna pada kelompok NEE (89%) dibanding kortikosteroid (17%). Kesimpulan. Pemberian NEE sama efektif dengan kortikosteroid untuk induksi remisi penyakit Crohn pada anak. Namun, pemberian NEE perlu direkomendasikan karena efek penyembuhan mukosa yang lebih baik.
Faktor Risiko Diare Persisten pada Pasien yang Dirawat di Departemen Ilmu Kesehatan Anak RS Dr. Cipto Mangunkusumo Jakarta IGN Sanjaya Putra; Agus Firmansyah; Badriul Hegar; Aswitha D Boediarso; Muzal Kadim; Fatima Safira Alatas
Sari Pediatri Vol 10, No 1 (2008)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp10.1.2008.42-46

Abstract

Latar belakang. Program pengobatan rehidrasi oral telah berhasil mengontrol kematian akibat diare akut.Sekitar 3%-20% kasus diare akut pada anak akan berkembang menjadi diare persisten. Kematian akibatdiare persisten cukup tinggi ± 65% dari seluruh kematian akibat diare.Tujuan. Menentukan faktor risiko terjadinya diare persisten dan mengukur besar pengaruh tiap faktorrisiko tersebut terhadap terjadinya diare persisten pada anak yang dirawat di ruang rawat inap bagian anakRS Dr. Cipto Mangukusumo Jakarta.Metode. Rancang penelitian retrospektif, kasus-kontrol. Data penelitian diperoleh dari catatan medikpasien, semua pasien (54 pasien) diare persisten yang dirawat mulai 1 Januari 2004-30 Juni 2007 yangmemenuhi kriteria inklusi dipilih sebagai kasus dan 108 pasien diare akut dipilih secara consecutive samplingsebagai kontrol.Hasil. Pada analisis univariat didapatkan perbedaan bermakna antara 54 pasien dengan diare persisten(kasus) dan 108 pasien dengan diare akut (kontrol) dalam hubungan melanjutnya diare akut menjadi diarepersisten pada faktor risiko: pemberian antibiotik (p=0,042, RO :1,984, IK : 0,021-3,854), anemia (p=0,005,RO :2,568, IK : 1,313-5,024 ) dan malnutrisi (p= 0,001, RO : 10,974, IK :3,442-34,814). Pada regresilogistik multivariat, dua faktor risiko memperlihatkan hubungan yang bermakna yaitu anemia (p=0,025,RO :2,374, IK : 1,117-5,047) dan malnutrisi (p= 0,001, RO : 12,621, IK :3,580-44,814).Kesimpulan. Anemia dan malnutrisi pada diare akut merupakan faktor risiko untuk melanjutnya diare akutmenjadi diare persisten. 
Gambaran Derajat Dehidrasi dan Gangguan Fungsi Ginjal pada Diare Akut Sulaiman Yusuf; Syafruddin Haris; Muzal Kadim
Sari Pediatri Vol 13, No 3 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (69.899 KB) | DOI: 10.14238/sp13.3.2011.221-5

Abstract

Latar belakang. Diare akut merupakan salah satu masalah kesehatan yang cukup banyak ditemukan pada bayi dan anak. Gejala utamanya dehidrasi atau kekurangan cairan dalam tubuh sehingga menyebabkan penurunan volume ekstraselular yang menyebabkan berkurangnya perfusi jaringan memicu gangguan fungsi organ-organ tubuh salah satunya penurunan fungsi ginjal.Tujuan. Mengetahui gambaran derajat dehidrasi dan gangguan fungsi ginjal pada diare akut.Metode. Penelitian deskriptif dengan pendekatan cross sectionalyang ditujukan untuk membuat deskripsi atau gambaran derajat dehidrasi dari diare akut dan gangguan fungsi ginjal pada pasien rawat inap anak Rumah Sakit Umum Daerah Dr. Zainoel Abidin (RSUDZA) Banda Aceh. Penelitian dilakukan pada Agustus sampai dengan bulan Desember 2010 dengan pengumpulan data, klasifikasi, dilanjutkan dengan analisis data.Hasil.Didapatkan 21 pasien diare akut yang memenuhi kriteria penelitian. Jumlah pasien berusia < 2 tahun 17, umur 2-15 tahun 4 anak. Jenis kelamin laki-laki 12 dan perempuan 4. Berdasarkan derajat dehidrasi didapatkan pasien diare akut tanpa dehidrasi 8, dehidrasi ringan sedang 11, dan dehidrasi berat 2. Laju filtrasi glomerulus (LFG) berdasarkan kriteria RIFLE ditemukan pasien diare akut dengan risk 6, dan injury1.Terdapat 2 masuk kriteria riskdari 8 pasien diare akut tanpa dehidrasi, 3 masuk kriteria riskdari 11 pasien diare akut dehidrasi ringan sedang, dan 1 masuk kriteria injurydari 2 pasien diare akut dengan dehidrasi berat.Kesimpulan. Semakin berat derajat dehidrasi maka semakin tinggi risiko terjadi gangguan fungsi ginjal.
Epidemiology of Rotavirus diarrhea in children under five: A hospital-based surveillance in Jakarta Muzal Kadim; Yati Soenarto; Badriul Hegar; Agus Firmansyah
Paediatrica Indonesiana Vol 51 No 3 (2011): May 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (166.865 KB) | DOI: 10.14238/pi51.3.2011.138-43

Abstract

Background Rotavirus is still a major cause of acute diarrhea in children around the world, both in developed and developingcountries. WHO Surveillance from 2001 to 2008 showed that in children under five years of age treated for acute diarrhea, on average 40% of cases were caused by rotavirus. A previous study in Indonesia showed that the incidence of rotavirus diarrhea in children ranged from 20%􀁑60% of diarrhea cases. However, there have been few studies identifying the genotypes of rotavirus strains in Indonesia. This infonnation is indispensable for manufacturing vaccines.Objective To examine the epidemiology of rotavirus diarrhea, including genotypes and clinical characteristics, in children under five years who were hospitalized in Jakarta.Methods This study was a prospective surveillance conducted at Cipto Mangunkusumo Hospital, Jakarta from January to December 2007 investigating hospitalized children under five years of age who suffered from acute diarrhea.Results Ninety􀁑nine patients joined the study. The incidence of rotavirus infection in this study was 67%. The youngest was 2months of age and the oldest 54 months of age, Mth an average age of 13.6 months. As much as 92% of rota virus diarrhea was found in subjects aged 3􀁑23 months, Mth a peak age of 12􀁑23 months. Nutritional status, degree of dehydration, bloating, fever, blood in stool, and mucus in the feces were not significantly different between rotavirus and non􀁑rotavirus diarrhea. Vomiting tended to be more frequently experienced by children Mth rotavirus diarrhea than those with non􀁑rotavirus (88% vs. 67%). There was no clear, seasonal pattern for rotavirus diarrhea. Most G genotypes in this study were G1 (35%), G9 (12.5%), G2 (7.5%) and the majority of P genotypes were P6 (52.5%), P8 (17.5%) and P4 (10%).Conclusions The incidence of rotavirus diarrhea in hospitalized children under five years of age in Jakarta was 67%, with apredominance ofG1, G9 and G2 genotypes. 
Behavior and emotional problems in children with mental retardation Soedjatmiko Soedjatmiko; Muzal Kadim; Bambang Madiyono; Mardjanis Said
Paediatrica Indonesiana Vol 44 No 3 (2004): May 2004
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (311.011 KB) | DOI: 10.14238/pi44.3.2004.90-4

Abstract

Background Behavior and emotional problems in a mentally re-tarded child can inhibit the educational process of the child.Objectives The aims of this study were to find out the prevalenceof behavior and emotional problems in children with mental retar-dation as reported by parents and to assess associated risk fac-tors consisting of mother’s psychopathology, marital discord, malesex, child’s age, socioeconomic status, and family size.Methods This cross sectional study was carried out on 63 chil-dren with mental retardation in a school for retarded children, SLBC Asih Budi I, from January until March 2003. Parents were inter-viewed at school and home using special questionnaires, the ChildBehavior Checklist (CBCL) and Symptom Checklist-90 (SCL-90).Results The prevalence of behavior and emotional problems inthis study was 52%. The majority of behavior and emotional prob-lems were anxious/depressed (18%) and withdrawn (16%). Malesex and age group of 12-18 year-old were not risk factors of be-havior and emotional problems (OR=0.49, p=0.190 and OR=1.14,p=0.94, respectively) while socioeconomic status, family size, andmother’s psychopathology were risk factors (OR= 4.08, p=0.008;OR=4.17, p=0.014; OR=9.28, p=0.018; respectively). There wasa correlation between behavior and emotional problems of chil-dren and marital discord.Conclusion The prevalence of behavior and emotional problemswas 52% in which the majority was internalizing disorder. Risk fac-tors for behavior and emotional problems were mother’s psycho-pathology, four or more children in the family, low socioeconomicstatus, and marital discord
Gut wall integrity in exclusively breastfed vs. formula-fed infants Nur Hayati; Muzal Kadim; Irawan Mangunatmadja; Soepardi Soedibyo; Evita Bermansyah Ifran; Hikari Ambara Sjakti
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (323.171 KB) | DOI: 10.14238/pi56.4.2016.199-204

Abstract

Background Breast milk has bioactive substances that modulate gastrointestinal maturation and maintain mucosal integrity of the gut in infants. Markers that are both non-invasive and reliable, such as fecal alpha-1 antitrypsin (AAT), calprotectin, and secretory immunoglobulin A (sIgA) have been used to assess gut integrity in adults. Higher AAT levels may imply greater enteric protein loss due to increase intestinal permeability of immaturity gut.Objective To assess and compare gut integrity of exclusively breastfed (BF) and exclusively formula fed (FF) infants aged 4-6 months.Methods Subjects were 80 healthy infants (BF=40; FF=40), aged 4-6 months who visited the Pediatric Polyclinic at St. Carolus Hospital, and lived in Pasar Minggu or Cempaka Putih Districts, Jakarta. The fecal AAT was analyzed by an ELISA method. Mann-Whitney and unpaired T-test were used to analyze possible correlations between feeding type and gut integrity.Results The BF group had significantly higher mean fecal AAT than the FF group (P=0.02). Median sIgA levels were not significantly different between groups (P=0.104). The FF group had a higher mean fecal calprotectin level but this difference was also not significant (P=0.443). There was a significant correlation between breastfeeding and mean fecal AAT level (P=0.02), but no significant correlation with calprotectin (P=0.65) or sIgA (P=0.26).Conclusion The breastfed group shows better mucosal integrity compared to the formula fed group. Higher mean fecal AAT level in the BF group is related to the AAT content of breast milk. Therefore AAT content of BF group is actually lower than formula fed group which shows greater mucosal integrity in BF group.
The relationship between thrombocytopenia and intraventricular hemorrhage in neonates with gestational age Idha Yulandari; Lily Rundjan; Muzal Kadim; Pustika Amalia; Haryanti F. Wulandari; Setyo Handryastuti
Paediatrica Indonesiana Vol 56 No 4 (2016): July 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (303.481 KB) | DOI: 10.14238/pi56.4.2016.242-50

Abstract

Background The prevalence of thrombocytopenia in neonates ranges from 22 to 35%, and one of the most feared complica­tions is intraventricular hemorrhage (IVH). Previous research in Cipto Mangunkusumo Hospital (CMH), Jakarta reported a high incidence of IVH (43.47%) in infants with a gestational age of <35 weeks. Intraventricular hemorrhage causes disturbances in neurological development and can be fatal. In Indonesia, re­search on the relationship between thrombocytopenia and IVH has been limited.Objective To study the relationship between thrombocytopenia and IVH in neonates with gestational age <35 weeks and assess for a correlation between the severity of thrombocytopenia and the severity of IVH.Methods This cross-sectional study was performed by reviewing medical records in the Neonatology Division of the Child Health Department, University of Indonesia, CMH. Subjects were neonates hospitalized from January 2012 to December 2014 with IVH. Subjects were categorized into either mild to moderate IVH (grade ≤2) or severe IVH (grade >2). Thrombocyte counts were recorded on the same day as the diagnosis of IVH.Results The risk of severe IVH was 28.2% in neonates with thrombocyte counts <100,000/uL, and 10.4% in neonates without thrombocytopenia (P=0.014). Multivariate analysis revealed that gestational age <32 weeks and the use of respira­tory support (ventilator and high frequency oscillatory ventila­tion) had significant associations with severe IVH. However, multivariate analysis did not show a significant relationship between thrombocytopenia and severe IVH (correlation coef­ficient = 0.21).Conclusion Thrombocytopenia is not significantly associated with the incidence of severe IVH based on multivariate analysis. Also, the severity of thrombocytopenia has no correlation with the severity of IVH.
Covert bacteriuria in schoolchildren Taralan Tambunan; Yuli Kumalawati; Partini P. Trihono; Astuti Giantiti; Muzal Kadim; Vera Irawani
Paediatrica Indonesiana Vol 41 No 1-2 (2001): January 2001
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (269.965 KB) | DOI: 10.14238/pi41.1.2001.38-41

Abstract

Covert bacteriuria is defined as significant bacteriuria detected during a screening program, This study was done as a pari of pilot program held by Medical School University of Indonesia namely Community Health Program. The screening was carried out at four Primary School al Cibubur Subdistrict Eastern Jakarta. The population target was focused on children at the third, four1h and fifth grade from each school. Screening urinalyses include examinatiOfl for the presence of glucose, protein, blood and bacteria. There were 460 children enrolled to this study, but only 449 cases were eligible for assessment comprising 217 males and 232 females aged ranged between 7.4-14.1 years. Covert bacteriuria were found in ten cases (2.22%), comprising five males and females consecutively. Antibiotics were not given. Repeated urine culture done two weeks later revealed that six cases cured spontaneously, four other cases still showing bacteriuria although all cases remain asymptomatic. We conclude that covert bacteriuria in schoolchildren is a benign condition, most of them are spontaneously cured without antibiotic treatment. This conclusion is in accordance with the opinion of most authors that screening for bacteriuria in healthy children does not have a place in any age group including schoolchildren.
Co-Authors Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Agus Firmansyah Amrina Rasyada Andini Striratnaputri Anjar Setiani Aryono Hendarto Astuti Giantiti Aswitha Boediarso Aswitha Boediharso Aswitha Boediharso Aswitha D Boediarso Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Badriul Hegar Bambang Madiyono Bambang Supriyatno Berlian Hasibuan Bernie Endyarni Medise Bertri Maulidya Masita Chozie, Novie A. Cindy Gisella Zahrany Deddy S Putra Deddy S Putra Evita Bermansyah Ifran Ezy Barnita Farahdina Shahnaz Fatima Safira Alatas, Fatima Safira Fatima Safra Alatas Handayani, Dyah Suci Hartono Gunardi Haryanti F. Wulandari Hasri Salwan Hikari Ambara Sjakti, Hikari Ambara Himawan Aulia Rahman I Gusti Ngurah Sanjaya Putra Idha Yulandari Idham Amir Irawan Mangunatmadja Jennie Dianita Sutantio Jeshika Febi Kusumawati Kholisah Nasution Laila, Dewi S. Lily Rundjan Lukito Ongko Mardjanis Said Mardjanis Said Muhammad Indera Ramadani Mulyadi M. Djer Najib Advani Nina Dwi Putri Nur Hayati Partini P. Trihono Perdana, Andri Permatasari, Ruth K. Pramita G D Pramita GD Pustika Amalia Ratno Juniarto Marulitua Sidauruk Setia Budi Setyo Handryastuti Simanjuntak, Sumardi F. Soedjatmiko Soedjatmiko Soepardi Soedibyo Sri Kesuma Astuti Sudung Oloan Pardede Sulaiman Yusuf Syafruddin Haris Tantri, Aida Rosita Taralan Tambunan Teny Tjitra Sari, Teny Tjitra Titi Sunarwati Sularyo Titis Prawitasari, Titis Vera Irawani Wahyu Ika Wardhani William Cheng Yati Soenarto Yuli Kumalawati Yvan Vandenplas