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All Journal Sari Pediatri Paediatrica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia 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 Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Neutrophil-to-lymphocyte ratio as a predictor of low cardiac output syndrome after open heart surgery in children with congenital heart disease Laila, Dewi S.; Perdana, Andri; Permatasari, Ruth K.; Kadim, Muzal; Advani, Najib; Supriyatno, Bambang; Chozie, Novie A.; Djer, Mulyadi M.
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.v4i2.736

Abstract

Neutrophil-to-lymphocyte ratio (NLR) as a predictor in determining low cardiac output syndrome (LCOS) has not been widely reported. The aim of this study was to explore the role of pre-surgery, 0-, 4-, and 8-hour post-surgery NLR as predictors of LCOS incidence after open heart surgery in children with congenital heart disease (CHD). This study used a prognostic test with a prospective cohort design and was conducted from December 2020 until June 2021 at the cardiac intensive care unit (CICU) of Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The subject consisted of children aged one month to 18 years who underwent open heart surgery using a cardiopulmonary bypass (CPB) machine. A receiver operating characteristic curve was applied to identify the predictive performance of NLR for poor outcomes (LCOS incidence). Out of 90 patients included in the study, 25 (27.8%) of them developed LCOS between 3 to 53 hours post-surgery. All NLR values (pre-surgery and 0-, 4-, and 8-hours post-surgery) were associated with the incidence of LCOS. Pre-surgery NLR (cut-off value ≥0.88) had a fair predictive value (area under curve (AUC) 70; 95%CI: 57–83) for predicting LCOS incidence with sensitivity and specificity of 64% and 64.62%, respectively. NLR 0-hour post-surgery (cut-off value ≥4.73) had a good predictive value (AUC 81; 95%CI: 69–94) for predicting LCOS incidence, with 80% sensitivity and 80% specificity. NLR 4- and 8-hours post-surgery had very good predictive values (AUC 97%; 95%CI: 92–100 and 98; 95%CI: 94–100, respectively), with cut-off values ≥6.19 and ≥6.78, had the same 92% sensitivity and the same 96% sensitivity. The presence of LCOS was associated with mortality (odds ratio of 5.11 with 95%CI: 3.09–8.46). This study highlights that pre-surgery, 0-, 4-, and 8-hours post-surgery NLR can be predictors of LCOS after open heart surgery in children with CHD.
Cholestasis as Primary Manifestation of Cytomegalovirus Infection: A Case Report Handayani, Dyah Suci; Kadim, Muzal
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 3 No. 4 (2024): APGHN Vol. 3 No. 4 November 2024
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.3.4.2024.33-42

Abstract

Background: Jaundice, marked by yellow discoloration of the sclera, skin, and mucous membranes due to bilirubin accumulation, can be physiological in neonates but may also signal pathological conditions like cholestasis. Cholestasis is commonly associated with biliary atresia; however, it can arise from various causes such as cytomegalovirus (CMV) infection. Thus, this study aims to discuss the diagnostic approach on neonatal cholestasis as the main manifestation in CMV infection. Case: A 2-years-old boy referred to the hospital with chief complaint of jaundice in both eyes and skin since 4 days of age and persisted until the age of 40 days old. Abdominal ultrasound in prior hospital revealed obstruction of bile duct which indicative for biliary atresia. However, subsequent abdominal and ARFI ultrasound showed no showed results inconsistent with biliary atresia. Furthermore, other examinations indicating infection, which were confirmed as CMV infection through serological and PCR test. Patient was then treated using valganciclovir treatment. Discussion: The diagnostic approach for cholestasis includes comprehensive anamnesis and physical examination, laboratory tests including complete blood count, bilirubin levels, liver function analysis, and coagulation factors, as well as ultrasound. CMV infection should be considered a potential cause of neonatal cholestasis, even in the absence of specific manifestations beyond jaundice and gastrointestinal symptoms. Conclusion: CMV infection can present solely with cholestasis and gastrointestinal symptoms, without other typical CMV manifestations. Thus, comprehensive evaluation, CMV screening, and careful assessment of the patient’s condition are essential for accurate management.
Perbandingan Efektivitas dan Keamanan Ligasi dengan atau Tanpa Propranolol pada Anak dengan Hipertensi Portal Kadim, Muzal; Rasyada, Amrina
Sari Pediatri Vol 26, No 6 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.6.2025.389-98

Abstract

Latar belakang. Hipertensi portal (HP) didefinisikan sebagai peningkatan tekanan portal >5 mmHg, jika >12 mmHg dapat terjadi perdarahan saluran cerna. Tindakan ligasi menjadi pilihan utama untuk eradikasi varises, tetapi penggunaan propranolol masih menjadi kontroversial mengingat efek samping yang timbul.Tujuan. Mengetahui efektivitas dan keamanan propranolol untuk mencegah perdarahan varises pada hipertensi portal.Metode. Penelusuran pustaka database elektronik, yaitu Pubmed, Cochrane, dan Embase dengan kata kunci keywords “pediatric” OR “child”, “AND” ‘portal hypertension”, “AND” “ligation” OR “endoscopy”, AND “propranolol” OR “beta blocker”, AND “gastrointestinal bleeding” OR “esophageal varices rupture” OR “variceal bleeding”.Hasil. Penelusuran literatur diperoleh 3 artikel yang kemudian dilakukan telaah kritis. Studi oleh Santos dkk didapatkan tidak ada perbedaan bermakna antara kelompok ligasi dengan atau tanpa propranolol terhadap kejadian perdarahan saluran cerna. Studi Pimenta dkk menunjukkan tidak ada perdarahan saluran cerna yang terjadi pada kelompok ligasi dan propranolol. Sementara studi Quintero dkk menyatakan bahwa ligasi saja cukup aman dan efektif dalam mencegah perdarahan saluran cerna, dengan Hazard Ratio (HR) kelompok propranolol 2.6 (IK 1.53-3.67). Efek samping propranolol terjadi pada ketiga penelitian, secara berurutan sebanyak 16%, 41% dan 21.8%, berupa bronkospasme, hipotensi, dan penurunan kesadaran.Kesimpulan. Berdasarkan penelitian ilmiah yang telah dipaparkan dapat disimpulkan bahwa pemberian propranolol belum direkomendasikan karena efek samping yang ditimbulkan. Efektivitas ligasi dengan atau tanpa propranolol tidak memiliki perbedaan bermakna.
Early enteral nutrition administration and time to achieve resting energy expenditure in critically ill children Yulman, Annisa Rahmania; Pudjiadi, Antonius Hocky; Tridjaja, Bambang; Kadim, Muzal; Prawitasari, Titis
Paediatrica Indonesiana Vol. 65 No. 5 (2025): September 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.5.2025.390-8

Abstract

Background Malnutrition in critically ill children remains a significant concern, as a standardized nutritional support protocol has yet to be developed. Resting energy expenditure (REE) is recommended as a parameter for determining the fulfillment of energy needs in critically ill children, which should ideally be achieved within 72 hours. To achieve these energy needs, enteral nutrition (EN) is believed to have a lower mortality rate and a shorter length of stay compared to parenteral nutrition (PN). Objective  To evaluate the factors associated with delayed EN initiation and late achievement of REE.  Methods Data consisting of age, sex, nutritional status, timing of EN initiation, time required to achieve REE targets, PELOD-2 score, use of ventilators, duration of ventilation, hemodynamic status, use of inotropes and inotropic score, use of sedation, gastrointestinal symptoms, procedures performed during treatment, and technical issues were collected retrospectively from medical records from 2017 – 2018 in the Pediatric Intensive Care Unit (PICU) at Dr. Cipto Mangunkusumo Hospital. The REE was calculated using Schofield formula based on age and sex. These data were used to compare the proportion of the subjects receiving early EN (<48 hours) and delayed EN (>48 hours) and those who achieved REE <72 hours and delayed REE (>72 hours). Multivariate analysis was performed to determine which factors affecting late EN initiation and delayed REE achievement using logistic regression analysis. Results Of 203 subjects, 63.1% received early EN and 67.5% achieved REE at ≤72 hours. Delayed EN was associated with post-abdominal surgery (OR 10.89; 95%CI 4.31 to 27.50; P<0.001), ventilator use (OR 4.60; 95%CI 1.78 to 11.90; P=0.004), inotrope use (OR 4.18; 95%CI 1.56 to 11.17; P=0.002), gastrointestinal symptoms (OR 3.41; 95%CI 1.59 to 7.29; P=0.002), and abnormal nutritional status (OR 2.49; 95%CI 1.09 to 5.72; P=0.031). The REE >72 hours was associated with late EN (OR 20.62; 95%CI 6.48 to 65.65; P<0.001), enteral intolerance after receiving EN (OR 14.77; 95%CI 4.40 to 49.6; P<0.001), and PELOD-2 score ≥7 (OR 3.98; 95%CI 1.01 to 15.66; P=0.048). Conclusion The prevalence of EN and REE within 72 hours in the PICU is quite encouraging. Factors contributing to delayed EN administration include post-abdominal surgery, ventilator use, inotrope use, gastrointestinal symptoms, and abnormal nutritional status.  Delayed EN >48 hours, enteral intolerance after receiving EN, and PELOD-2 score >7 were the factors contributing to delayed REE achievement. However, these delays can be reduced by developing a comprehensive enteral feeding protocol. The factors influencing delayed EN and late REE achievement are an important basis for designing enteral feeding protocols to improve the clinical outcomes of critically ill children in the PICU.
Recurrent Esophageal Stricture in a Child Post Steven-Johnson Syndrome: A Case Report Rahman, Himawan Aulia; Astuti, Sri Kesuma; Kadim, Muzal
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 3 No. 1 (2024): APGHN Vol. 3 No. 1 February 2024
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.3.1.2024.33-40

Abstract

Background: Esophageal stricture is an abnormal narrowing of the esophageal lumen, resulting in dysphagia. Despite its rarity, this condition could be caused by various etiologies, including Steven-Johnson Syndrome (SJS). In some cases, stricture could recur, which complicates the management. This case report presented a rare case of refractory esophageal stricture in children with Steven-Johnson Syndrome. Case: A 5-years-old boy with a prior history of SJS presented with dysphagia for one month. The patient experienced choking, blood vomiting, stomatitis, swelling on the lips, and difficulty in swallowing solid food. Barium meal and EGD test confirmed the diagnosis of esophageal strictures. The patient then underwent dilation using bougie dilator. However, he continued to experience dysphagia, resulting in a total of 15 serial dilation sessions. Discussion: Esophageal dysphagia is observed in patients who experience difficulty swallowing solid food. SJS can contribute to the development of esophageal dysphagia by causing inflammation of the esophageal mucosa, resulting in lesions and strictures. In patients with esophageal strictures, two types of dilation methods are available: bougie dilator with wire guidance (Savary-Gilliard) and balloon dilator, with the current consensus for dilation procedures supporting the rule of three. For patients with refractory strictures, other modalities such as mitomycin-C injection and stent placement are also available. Esophageal replacement surgery is considered as the last resort for refractory stricture patients who have not responded to previous treatments. Conclusion: Steven-Johnson Syndrome is a rare cause of esophageal strictures. The management of refractory esophageal stricture requires a comprehensive subspecialty care and long-term monitoring.
Konstipasi Fungsional pada Anak Kadim, Muzal
Majalah Kedokteran Indonesia Vol 71 No 4 (2021): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.71.4-2021-371

Abstract

Constipation has a negative impact, both for the child and their family, because it can reduce the quality of life, as well as impact on health care costs. The diagnosis of functional constipation is based on Rome IV criteria. The prevalence of functional constipation is related to geography, dietary habits and types, and exposure to stressful life events for children. Although most constipation in children is functional, an organic disorder must be excluded by looking for any alarm signs.
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 Astuti, Sri Kesuma 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 Bambang Tridjaja AAP, Bambang Tridjaja 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 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 Pudjiadi, Antonius Hocky Pustika Amalia Rahman, Himawan Aulia Ratno Juniarto Marulitua Sidauruk Setia Budi Setyo Handryastuti Simanjuntak, Sumardi F. Soedjatmiko Soedjatmiko Soepardi Soedibyo 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 Yulman, Annisa Rahmania Yvan Vandenplas