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All Journal Berkala Ilmu Kesehatan Kulit dan Kelamin Media Dermato-Venereologica Indonesiana Journal of General Procedural Dermatology and Venereology Indonesia Jurnal Muara Medika dan Psikologi Klinis Jurnal MedScientiae Cermin Dunia Kedokteran
Sri L. Menaldi
Department Of Dermatology And Venereology Faculty Of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Failure to use routine prevention of disability (POD) assessment resulting In permanent disability Zoulba, Erika; Sjamsoe, Emmy Soedarmi; Menaldi, Sri Linuwih; Marissa, Melani; Irawan, Yudo
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 2
Publisher : UI Scholars Hub

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Abstract

Disability is one of problems in leprosy or Morbus Hansen (MH), which can cause the patient loose his autonomy and may affect his social relationship with family and community. Disability occurs due to neurological inflammation that can manifest as silent neuritis (which develops without any pain). Silent neuritis can be recognized early with a routine prevention of disability (POD) assessment. A 19-year-old male patient was referred from a District General Hospital with a history of numbness and stiffness of his 4th and 5th fingers of his left hand since 1 month before admittance. The patient was refered by Community Health Center (CHC or PUSKESMAS) after a one year treatment and RFT. During his treatment at the CHC, no assessment of peripheral nerve or POD had ever been performed. The POD assessment at our hospital demonstrated sensory deficit at some points of assessment on both palms and reduced muscle strength of the first and 5th fingers in both hands. Nerve conduction velocity (NCV) performed at the outpatient of Neurology Department, showed multiple mononeuropathy MH with irreversible damage. Nerve damage is still considered reversible when it occurs less than 6 months. In this case, the silent neuritis was not detected early and there was delayed treatment; as showed by NCV which revealed a manifestation of irreversible nerve damage. Routine POD assessment may detect the condition and appropriate treatment may overcome the nerve damage.
Occupational skin cancer and precancerous lesions Raissa, Fifinela; Rahmayunita, Githa; Menaldi, Sri Linuwih; Soemarko, Dewi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 3
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Occupational skin cancer and precancerous lesions are skin disorders caused by exposure to chemical carcinogens such as polycyclic hydrocarbons and arsenic, or radiation, such as ultraviolet light and ionizing light in the workplace. Annual increase in skin cancer incidence is believed to be related to various factors such as frequent intense sunlight exposure (i.e. at work, recreational activities, and sun-tanning habit), ozone depletion, an increase in number of geriatric population, and an increase of public awareness in skin cancer. The most common occupational skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma. Examples of occupational precancerous lesion of the skin are actinic keratosis and Bowen’s disease. Particular diagnostic criteria to diagnose occupational diseases has been developed. Early detection of occupational skin cancer and precancerous lesion is necessary. An effective prevention program consists of primary prevention such as prevention of hazardous material exposure, secondary prevention such as early detection of disease for early intervention, and tertiary prevention such as minimizing long-term impact of the disease.
Neural Leprosy: A case report Widiawaty, Alida; Sjamsoe-Daili, Emmy Soedarmi; Olivia, Taruli; Menaldi, Sri Linuwih; Marissa, Melani; Octaviana, Fitri
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 3
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Neural leprosy is characterized by neurological deficit without skin lesions, with a prevalence ranging from 1% to 17.7%. Diagnosis might be difficult and need a multidisciplinary approach. This is a case of axonal type motor and sensory polyradiculoneuropathy of the peripheral facial nerve. A 26-year-old woman was referred from the neurology clinic with facial paralysis, suspected as leprosy. Physical examinations were as follows: no skin lesions, left eye lagophthalmos, thickening of right lateral peroneal and bilateral posterior tibial nerves, sensory impairment, peripheral bilateral facial palsy, and wasting of bilateral distal small muscles of the hands, with normal autonomic function. Nerve Conduction Study revealed multiple demyelinating mononeuropathy of upper and lower extremities. Her serum anti-PGL-1 IgM level was 1721 μ/mL, but after three months of treatment with MDT-PB regimen, it increased to 2815μ/mL. Therefore, the treatment was switched to MDT-MB regimen and 30 mg prednisone. The patient is still undergoing treatment. There has been a slight improvement after treatment with MDT-MB regimen. Nerve biopsy is the gold standard for diagnosis but has its limitations. However, serological test of anti PGL-1 can be a marker and a useful tool as an additional test to confirm the diagnosis, especially for patients with nerve impairments. Difficulties are due to the absence of skin lesions and neuropathy which may be caused by other diseases. Both diagnosis and treatment require multidisciplinary approach. Treatment given is intended to correct nerve damage and prevent further disabilities. Click here to edit this text or paste your document here to convert it to HTML �� This demo allows you to test the features of this online HTML converter. Type in one of the fields and see the other one changing in real time! Set up the cleaning options and press ▼ Clean Work with any of the text areas and see the other one changing in real time: Left: Preview Right: Source code Preview how your document will look when published. Adjust the syntax highlighted HTML code. Check out Pranx.com for nice online pranks.
Suspected resistance of MDT-MB in Multibacillary Leprosy of Hansen's disease: Two case reports Irawan, Yudo; Menaldi, Sri Linuwih; SD, Emmy Soedarmi; Marissa, Melani; Zoulba, Erika
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 3
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Resistance to multidrug therapy (MDT) is one of the complications in the treatment of Hansen’s disease/Morbus Hansen (MH). There are two types of resistancy, which are primary and secondary. MDT-multibacillary (MB) resistance must be suspected when no clinical improvement and the acid-fast bacilli (AFB) index is not reduced after 12 months of therapy. A 28-year-old woman with paresthesia on her face, arms and legs since 2.5 years ago, accompanied by thickening of the right posterior tibial nerve. The AFB examination showed a bacteriological index (BI) of 15/6 and morphological index (MI) of 0.50%. The second case, a 42-year-old man came with paresthetic lesions on his face, chest, back, both arms and legs since 2 years ago, accompanied by thickening of ulnar and lateral peroneal nerve. The BI was 12/5 and the MI was 0.40%. Both patients were diagnosed with borderline lepromatous type of MH and received MDT-MB for 12 months. Diagnosis of suspected resistance was established because no clinical improvement or any significant decrease of AFB index after completing the MDT treatment. The patients had secondary resistance after polymerase chain reaction evaluation showed that they were still rifampicin-sensitive. There was clinical improvement and significant decrease in FAB index after the patients continued the MDT-MB treatment with 600 mg additional rifampicin. The diagnosis of bacterial resistance should be made based on clinical evaluation before completion of treatment. Based on the two case reports, the resistance suspected may be secondary. Treatment using additional regimen can be initiated once the resistance has been proven.
Lucio’s phenomenon: A report on six patients in a tertiary referral hospital in Indonesia Marissa, Melani; Rihatmadja, Rahadi; Surya, Denny; Lim, Henry W; Menaldi, Sri Linuwih
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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Background: Lucio's phenomenon (LP) is a rare variant of leprosy reaction, with the clinical manifestation of “necrotizing erythema.” LP was observed in patients with lepromatous leprosy who have not received or completed the treatment, and it is especially evident in patients with diffuse lepromatous leprosy (DLL), known as Lucio-Latapi’s leprosy. LP occurs due to M. leprae invading the blood vessels, causing endothelial damage that leads to thrombosis, ischemia, infarction, and tissue necrosis. The clinical features of the disease are erythematous lesions that can be accompanied by vesicles or bullae, with ulcers forming scar tissues. Histopathological examination can help establish the diagnosis of LP. Until now, there is still controversy about LP management. Multidrug therapy for multibacillary leprosy (MDT-MB) is the preferred line of treatment. Lucio-Latapi’s leprosy and LP are commonly found in Mexico and Central America, but rarely reported in Indonesia. Case Illustration: We report here the clinical description and development of six patients with LP observed in the tertiary referral hospital in Indonesia over a five-year period from 2013 to 2017. Discussion: All patients were diagnosed using clinical and histopathological examination, and all of them presented with ulceration and vasculitis. They were treated with MDT-MB WHO regimens and systemic corticosteroids. Five patients were alive, and one died due to extensive cutaneous lesions that lead to sepsis. Conclusion: Early diagnosis and prompt institution of multidrug therapy with systemic corticosteroids may improve the prognosis and outcome of LP.
Correlation between clinical and histopathological findings of five puzzling cases of cutaneous tuberculosis Miranda, Eliza; Widaty, Sandra; Sirait, Sondang Pandjaitan; Rizky, Luddwi Achmad; Menaldi, Sri Linuwih; Lim, Henry W
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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Background: Cutaneous tuberculosis refers to the clinical manifestation of extrapulmonary tuberculosis affecting the skin. Determining the type of cutaneous tuberculosis from a patient afflicted with is challenging because clinical and histopathological similarities exist between types. Moreover, confirming a diagnosis of cutaneous tuberculosis is difficult because of its similarity with other diseases. For instance, typical and atypical cutaneous tuberculosis may have similar manifestations, but each disease is managed by completely different approaches. Microbiological examination with polymerase chain reaction and bacterial culture are the gold standard methods used to confirm a diagnosis of cutaneous tuberculosis. However, results often demonstrate negative findings. Case Illustration: Five cases of cutaneous tuberculosis, which include two cases of tuberculosis verrucosa cutis, two cases of scrofuloderma, and one case of lupus vulgaris were presented in this article. Four of the five cases demonstrated significant improvement after initiation of an antituberculosis drug regimen. Discussion: Diagnosis of cutaneous tuberculosis in these cases was confirmed through clinical findings and histopathological and microbiological examination. Conclusion: A negative result following microbiological examination does not completely exclude the diagnosis of cutaneous tuberculosis. Investigating the pathognomonic findings of cutaneous tuberculosis through histopathological examination is important to differentiate among its types correctly. Therefore, correlations between clinical and histopathological results are essential to establish a diagnosis of cutaneous tuberculosis.
Purpuric lesion in a patient with leprosy: Was it a Lucio’s phenomenon or an epiphenomenon? Menaldi, Sri Linuwih; Marissa, Melani; Chairista, Inadia Putri; Lim, Henry W.; Rihatmadja, Rahadi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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Background: Lucio’s phenomenon (LP) is a severe necrotizing cutaneous reaction that occurs in patients with Lucio’s leprosy. The exact pathomechanism is not fully understood, but typically abundant acid-fast bacilli in the walls of blood vessels point to direct perturbation of blood supply to the epidermis. We report a case of LP where epidermal necrosis occurred in the absence of vascular invasion by mycobacteria, raising the question whether this was an epiphenomenon or a true LP. Case Illustration: A 34-year-old male was referred for an episodic swelling of his hands and feet that persisted for two years. There were signs of leprosy (diffuse shiny skin lesions, anesthesia, and anhidrosis of the extremities) with purpuric patches on lower extremities. The slit-skin smear test revealed a high index of acid- fast bacilli. Histopathological examination revealed epidermal necrosis and leukocytoclastic vasculitis without demonstrable bacillus. WHO multidrug regimen for leprosy and corticosteroids successfully cured the patient and prevented ulcer development. Discussion: Despite the presence of classical LP characteristics clinically and histologically, mycobacterium was absent in the vessels’ walls. We hypothesized that, in LP, vascular impairment might also be secondary due to antigen–antibody reaction and hypercoagulable state.Conclusion: Purpuric patches in Lucio’s leprosy might be the first sign of skin necrosis or vascular damage (purpura and ulceration). Besides the antimycobacterial drugs, anti-inflammatory drugs should be administered. Laboratory test for hemostasis might be advised.
Comparison between oral pentoxifylline + corticosteroid andoral corticosteroid alone for severe erythema nodosum leprosum Martinus, Martinus; Rihatmadja, Rahadi; Menaldi, Sri Linuwih
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 6, No. 1
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Background: Severe erythema nodosum leprosum (ENL) is common but difficult to treat. Long term use of systemic corticosteroid causes side effects. This study compares the use of a combination of pentoxifylline + oral corticosteroids with a single oral corticosteroid in leprosy patients with severe ENL reactions. Parameters measured include skin RSA score, systemic RSA, total corticosteroid dose, resolution time of skin lesions, improvement of pain VAS and treatment side effects.Methods: 29 subjects with severe ENL reactions are allocated randomly into two groups which receive oral pentoxifylline + methylprednisolone, and oral placebo + methylprednisolone for 12 weeks. The starting dose of pentoxifylline are 400 mg thrice daily for 4 weeks, tapered to 400 mg daily every 4 weeks. Methylprednisolone is based on WHO guideline. Results: In the end, the median of cutaneous RSA score in pentoxifylline vs placebo group is 4 (0-5) vs 3 (0-5). The median of systemic RSA score in pentoxifylline vs placebo group is 0 (0-6) vs 0 (0-5). The median of total corticosteroid doses in pentoxifylline vs placebo group is 156 (120-200) mg vs 136 (96-200) mg. The median of resolution time in pentoxifylline vs placebo group is 6 (0-12) weeks vs 6 (0-12) weeks. The median of change of pain VAS score in pentoxifylline vs placebo group is 5 (0-6) vs 3 (-3-6). No statistically significant difference (p>0,05) are found in all parameters, including side effects. Conclusion: Combination of oral pentoxifylline + corticosteroid is not proven to be more effective. Both are safe.
Item generation in the development of a questionnaire for predicting multidrug therapy compliance in leprosy Siskawati, Yulia; Asih, Sali Rahadi; Kekalih, Aria; Menaldi, Sri Linuwih; Herqutanto, Herqutanto; Bramono, Kusmarinah
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 7, No. 2
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Background: Lengthy therapeutic regimens in leprosy are prone to defaults, contributing to more antibiotic-resistant Mycobacterium. Intervening patients’ medical habits midway would be more complicated than understanding their perception of undergoing such regimens in advance. We study the factors considered relevant to leprosy patients’ compliance to construct a novel self-reporting questionnaire that can predict the patients’ adherence before initiating multidrug therapy. Methods: According to the Delphi methods, we conducted three rounds of interviews with twenty-three respondents from various backgrounds, including dermatologists, government officials, healthcare workers, and patients with leprosy, to infer the associated factors of the included items. Each item was scored using the Likert scale, and accepted items (scores above 75%) were classified into six-dimensional categories based on the health belief model theory. Result: The initial 236 items were simplified to 72 items. Then, a panel discussion was conducted to score each item. Finally, 48 items were accepted and categorized into 12 indicators from 6 dimensions. The 12 indicators encompass knowledge about leprosy, its severity, therapeutical options, stigma, challenges in the treatment maintenance, availability of medical facilities and workers, therapeutic impact, drug regulation, health personnel, personal beliefs, attitude, and motivation. (p Conclusion: The study identified 12 critical factors influencing adherence to leprosy treatment, contributing to the prevention of antibiotic-resistant mycobacterium and providing valuable insights through the predictive self-reporting questionnaire.
KEGAGALAN TERAPI PADA KUSTA TIPE LEPROMATOSA DAN FAKTOR YANG MEMENGARUHINYA: SEBUAH LAPORAN KA Joanne Natasha; Sri Linuwih Menaldi; Melani Marissa; Rizka Farah Hilma
Media Dermato-Venereologica Indonesiana Vol 49 No 2 (2022): Media Dermato-Venereologica Indonesiana
Publisher : Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia (PERDOSKI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33820/mdvi.v49i2.339

Abstract

Children is a group that is nine times more likely to contract leprosy. The finding of new cases of leprosy in children is a strong indicator that indicates the disease transmission is still ongoing. World Health Organization (WHO) in 2019 reported 14,981 out of 202,185 (7.4%) new cases of children. Cases of resistance to multidrug therapy (MDT) can be primary or secondary. It is important to detect drug resistance earlier considering children’s quality of life would be affected by leprosy complication. A 14 years old girl from Lebak Regency, Rangkasbitung, Banten was diagnosed as lepromatous type (LL) leprosy and a second grade disability on the 5th finger of her left hand. Unimproved clinical and increasing the morphological index (IM) on the 9th month of treatment from 0.16% to 1%, leading the patient experience the drug resistance. The polymerase chain reaction (PCR) examination did not show any mutation in the RpoB gene. Inadequate and irregular MDT consumption have the potential to cause secondary resistance and the risk of becoming primary resistance later. It is not easy to determine drug resistance in endemic areas. Morphological index monitoring should be closely watched before treatment is complete thus the modified therapy can be given earlier.
Co-Authors Agnes Sri Siswati Ahmad Fuady Aldri Frinaldi Alida Widiawaty Anum, Qaira Aria Kekalih Augustine D. Sukarlan Bagus Haryo Kusumaputra Bani, Anna Puspitasari Caroline Oktarina Chairista, Inadia Putri Cita Rosita Sigit Prakoeswa Dewi Matindas Dewi Sumaryani Soemarko Dharmayati B. Utoyo Dhelya Widasmara Diahtantri, Riyanti Astrid Diahtantri, Riyantia Astrid Emmy Soedarmi Sjamsoe Emmy Soedarmi Sjamsoe-Daili Erika Zoulba Evita H. Effendi Fifa Argentina Fifinela Raissa Fitri Octaviana Githa Rahmayunita Hansen Angkasa Herqutanto - Hirzi Zulkarnain Irawan, Yudo Irawati, Yunia Iwan Dwiprahasto Jayawarsa, A.A. Ketut Joanne Natasha Keumala Budianti, Windy Kurniawardhani, Dewinta Retno Kusmarinah Bramono Larisa Paramitha Lidwina Anissa Lili Legiawati Lim, Henry W Lim, Henry W. Lubis, Ramona Sari Luh Karunia Wahyuni, Luh Karunia Luh Made Mas Rusyati M. Yulianto Listiawan Mamuaja, Enricco Hendra Marissa, Melani Martinus, Martinus Medhi Denisa Alinda, Medhi Denisa Melani Marissa Melani Marissa Miranda, Eliza Muchtar, Vitayani Mughni, Fadhli Aulia Muhammad, Parikesit Mulianto, Nur Rachmat Olivia, Taruli Ova Emilia Rahadi Rihatmadja Regitta Indira Agusni Renni Yuniati Rizka Farah Hilma Rizky, Luddwi Achmad Rosdiana, Dewi Selvina Saleha Sungkar Sali Rahadi Asih Sandra Widaty SD, Emmy Soedarmi Sirait, Sondang Pandjaitan Siskawati, Yulia Siskawati, Yulia Sjamsoe, Emmy Soedarmi Sjamsoe-Daili, Emmy Soedarmi Surya, Denny Taruli Olivia Triana Agustin Victor Santawi Widiawaty, Alida Wresti Indriatmi B. Makes Yayi S. Prabandari Yeni Dwi Lestari Yudo Irawan Zoulba, Erika