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All Journal Sari Pediatri Paediatrica Indonesiana JOURNAL LA MEDIHEALTICO Archives of Pediatric Gastroenterology, Hepatology, and Nutrition

Mulya Rahma Karyanti, Mulya Rahma

Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo

Author-ID : 3210240

Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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Side effects of long-term antiepileptic drugs on renal tubules of Indonesian children Partini Pudjiastuti Trihono; Deasy Grafianti; Irawan Mangunatmadja; Mulya Rahma Karyanti
Paediatrica Indonesiana Vol 58 No 2 (2018): March 2018
Publisher : Indonesian Pediatric Society

Background Long-term treatment with antiepileptic drugs such as valproic acid (VPA) and carbamazepine (CBZ) may disrupt renal tubular function. Urinary N-acetyl-beta-D-glucosaminidase (NAG) may reflect tubular function and may be useful in detecting early-stage tubular injury. To date, no study has investigated the toxic effect of VPA and CBZ on renal tubules using urinary NAG in Indonesian children. Objectives To determine the toxicity of long-term VPA and/or CBZ treatment on renal tubules in children with epilepsy by measuring urinary NAG index (iNAG). Methods This cross-sectional study was conducted from January to March 2015 at Cipto Mangunkusumo Hospital and Anakku Clinic Pondok Pinang, Jakarta. We included children aged 3 to 16 years with epilepsy on VPA (n=36), CBZ (n=14), or VPA-CBZ combination (n=14) therapy. We measured urinary levels of creatinine and NAG. The urinary NAG reference value was obtained from age-matched healthy controls (n=30). To eliminate diurnal variations in NAG, iNAG was calculated by dividing urinary NAG by urinary creatinine. A urinary iNAG of more than two standard deviations above the mean for healthy children was considered elevated. Results Mean urinary iNAG values for the control, VPA, CBZ, and combination groups were 3.01, 5.9, 4.07, and 6.9 U/g, respectively. All treated groups had higher mean urinary iNAG values compared to the control group. Urinary iNAG was increased in 11/36 children on VPA, 2/14 children on CBZ, and 9/14 children on combination therapy. Conclusion Long-term VPA use may impair renal tubular function, as shown by the increased urinary iNAG. Combination therapy increases damage in the renal tubules.

Effects of probiotic on gut microbiota in children with acute diarrhea: a pilot study Dion Darius Samsudin; Agus Firmansyah; Eka Laksmi Hidayati; Irene Yuniar; Mulya Rahma Karyanti; Rosalina Dewi Roeslani
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

Background Acute diarrhea is a common health problem in Indonesia. During acute diarrhea, changes in gut microbiota are marked by decrease beneficial microbes Bifidobacterium and Lactobacillus, and increased pathogenic bacteria Enterobacter and Clostridium. Such microbial imbalances are known as dysbiosis. Treatment with probiotics may help repair dysbiosis, quicken healing time, and decrease complications. Objective To assess for dysbiosis during acute diarrhea, and determine if it can be normalized by probiotic treatment. Methods This placebo-controlled, unblinded clinical trial was performed in Budhi Asih District Hospital, Jakarta, from January to March 2018. Twenty-four children age 6-24 months with acute diarrhea and 12 healthy children were enrolled. First fecal specimen was collected for all subjects and analyzed using non-culture real time PCR to count the population of Lactobacillus, Bifidobacterium, Enterobacter, Clostridium, and all bacteria. Children with diarrhea were assigned to probiotic or placebo treatment for 5 days and the second fecal specimen was analyzed two weeks after the diarrhea subsided. Results Prior to treatment, significant higher amounts of Lactobacillus were observed in children with acute diarrhea than in healthy controls [median (interquartile range/IR): 1.52x103 (1.22x104) vs. 6.87x10 (2.41x102), respectively; proportion in percentage (from total bacteria population): 0.044% vs. 0.003%, respectively]. However, median (IR) Clostridium was significantly higher in healthy controls than in children with acute diarrhea [2.37x102 (4.64x103) vs. 4.67 (1.50x102), respectively (P<0.05), with proportion of 0.01% vs. 0.0001%, respectively]. Children who received probiotics had significantly higher count of Bifidobacterium compared to the placebo group [1.94x104 (4.97x104) vs. 1.74x103 (2.08x107), respectively, with proportion of 0.394% vs. 0.081%, respectively]. Conclusion This pilot study do not find evidence of dysbiosis in children with acute diarrhea. Group who received probiotic had higher Bifidobacterium count compared towards those who received placebo.

Atypical cinical manifestation of leprosy in Indonesian male adolescent: a case report Dion Darius Samsudin; Mulya Rahma Karyanti
Paediatrica Indonesiana Vol 61 No 3 (2021): May 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.3.2021.175-8

Leprosy, also known as Hansen’s disease, is a chronic infectious disease with high prevalence, but often neglected in Indonesia. Indonesia ranks the 3rd worldwide, after India and Brazil, with 17,439 new cases reported in 2019.1 This disease is caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus, which mainly affects the skin, peripheral nerves, upper respiratory tract mucosa, and eyes. Early diagnosis of the disease is fundamental, because delayed treatment may lead to severe deformities and disabilities.2 The current multidrug treatment (MDT) for leprosy is widely available in Indonesia for free. According to the World Health Organization (WHO),1 leprosy is one of 20 diseases recognised as neglected tropical diseases (NTDs), a group of disease which present significant burden amongst the poorest, often unheard communities. Eradication of leprosy is challenging because of the difficulty in diagnosis, as leprosy imitates various diseases, as well as treatment delay, high transmission, and social stigma. The regions of highest leprosy prevalence in Indonesia are in Java, Sulawesi, Maluku, and Papua.3,4 Among 17,439 new cases in 2019, 1,861 (10%) were children under 15 years of age.1 The detection of new cases in children indicates high transmission, and lack of mechanisms to control endemic infections.2 The aim of this report is to share our experience in diagnosing advanced stage leprosy with atypical clinical characteristics in a male adolescent.

Antimicrobial activity of homemade WHO ethanol-based hand rub solution in pediatric department, Dr. Cipto Mangunkusumo National Referral Hospital Nina Dwi Putri; Hindra Irawan Satari; Mulya Rahma Karyanti; Ari Prayitno; Pratama Wicaksana; Anis Karuniawati; Delly Chipta Lestari; Nabila Maudy Salma; Shindy Claudya Aprianti; Amalia Almira; Andi Annisa Rusyda Khafiyani
Paediatrica Indonesiana Vol 62 No 4 (2022): July 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.4.2022.232-6

Background Hand hygiene is essential in reducing healthcare-associated infections. Alcohol-based hand rub solutions have been reported to have superior antimicrobial efficacy on both bacteria and lipophilic viruses compared to washing with hand soap. In low- and middle-income countries, the cost of infection control poses a challenge. Our hospital produced an ethanol-based hand rub based on a WHO formulation to reduce the infection prevention costs. Objectives To identify the antimicrobial activity of a WHO ethanol-based hand rub solution against bacterial contamination on the hands of healthcare workers at the Department of Child Health, Dr. Cipto Mangunkusumo National Referral Hospital. Methods This cross-sectional study was performed on the hands of healthcare workers (physicians and nurses) working in the Department of Child Health, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta. A total of 225 specimens from 75 subjects were obtained by collecting swabs on both hands before and after participants worked in the Department of Child Health, Dr. Cipto Mangunkusumo General Hospital. Bacterial culture tests were performed to identify gram-positive and gram-negative bacteria. Bacteria were grouped into no-growth/Bacillus sp, Enterobacteriaceae, cocci, and non-fermenter groups. Results The use of our WHO ethanol-based hand rub solution, generally resulted in a statistically significant decrease in bacterial growth from 84 to 54.6%, before compared to after the hand rub was performed. In more detail, there was a 72.7% decrease in Enterobacteriaceae, a 71.4% decrease in non-fermenters, an 8.6% decrease in cocci and a 44.1% increase in the number of specimens showing no growth bacteria/Bacillus sp. Conclusion Our WHO ethanol-based hand rub has significant antimicrobial activity for common nosocomial pathogens (e.g., Staphylococcus aureus, P. aeruginosa, and K. pneumoniae).

The clinical and biomarker approach to predict sepsis mortality in pediatric patients Irene Yuniar; Mulya Rahma Karyanti; Nia Kurniati; Desti Handayani
Paediatrica Indonesiana Vol 63 No 1 (2023): January 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1.2023.37-44

Background Sepsis is a leading cause of pediatric morbidity and mortality. The prevalence of sepsis mortality in Indonesia varies between 22.5 to 52%. Objective To identify the clinical criteria for predicting sepsis mortality and evaluate the performance of the PELOD-2 score. Methods This retrospective cohort study included pediatric patients admitted to the emergency department or pediatric intensive care unit (PICU) of Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2015 to May 2020. Demographic characteristics (age and sex), clinical manifestations [nutritional status, presence of shock, need for intubation, source of infection, inotrope use, mean arterial pressure, pulse rate, respiratory rate, and Glasgow Coma Scale (GCS) score], laboratory [leukocyte, platelet, neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte count ratio (NLCR), procalcitonin, C-reactive protein (CRP), and lactate profile], PELOD-2 score, and mortality data were recorded as outcomes. Results We analyzed data from 241 sepsis subjects. The overall mortality rate was 65%. Shock [OR 3.2 (95%CI 1.80 to -5.55, P<0.001)], GCS <9 [OR 2.4 (95%CI 1.30 to 4.23, P=0.005)], inotrope use [OR 3.1 (95%CI 1.74 to 5.5, P<0.001)], CRP >33.5 mg/L [OR 2.5 (95%CI 1.14 to 5.35, P=0.02)], and lactate level >2.85 [OR 2.1 (95%CI 1.02 to 4.56, P=0.04)] were considered significant predictors of mortality. A PELOD-2 cut-off score of >8 had optimal sensitivity (81.2%) and specificity (72.9%) to predict mortality, with an OR of 11.6 (95%CI 5.72 to 23.5, P<0.001). Conclusion Shock, GCS score, inotrope use, CRP, and lactate level can serve as clinical biomarkers to predict mortality in pediatric sepsis. A PELOD-2 score of >8 can predict mortality with reasonably good sensitivity and specificity.

Risk Factors Affecting the Length of Improvement of Nutritional Status in Children with Congenital Heart Disease and Malnutrition Athiyatul Aufie; Sukman Tulus Putra; Mulya Rahma Karyanti; Yoga Devaera
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 2 No. 1 (2023): APGHN Vol. 2 No. 1 February 2023
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.2.1.2023.16-26

Background: To date, limited data are available regarding the factors that contribute to the delay of improvement in nutritional status as well as data regarding the optimal duration to improve malnutrition among children with congenital heart disease (CHD). Such data are important for pediatricians to fully optimize the nutritional status for those children prior to surgical procedure This study aims to identify those aforementioned factors in hope for better surgical outcome and quality of life of children with CHD. Methods: This is a descriptive analytic study using retrospective cohort design to identify the factors that contribute to the delay of improvement in nutritional status among children with CHD. Variables such as the type of CHD, classification of CHD complexity, pulmonary hypertension, heart failure, corrective surgery, the route of nutrition access, pneumonia, diarrhea, special diets and patients undergoing routine control at the nutrition outpatient clinic were evaluated in this study. Results: A total of 216 children with a diagnosis of CHD and weight-for-length z-score under -1 SD were included in this study. Based on multivariate analysis, there were two significant risk factors, which were the occurrence of diarrhea and consulting at nutrition outpatient clinic. The improvement in nutritional status in children with CHD who did not have diarrhea was faster than those with diarrhea (HR 1.94; 95% CI 1.10 – 3.47) (p value <0.025). Improvement in nutritional status of those children that underwent control at the nutrition outpatient clinic was faster than those who did not (HR 1.87; 95% CI 1.20 – 2.92) (p value <0.006). Conclusion: Risk factors that significantly lengthen the duration of improvement in the nutritional status of CHD patients were the incidence of diarrhea and those who did not undergo control at the nutrition outpatient clinic.

Pengendalian Varisela di Rumah Sakit Mulya Rahma Karyanti; Annisa Putri
Sari Pediatri Vol 25, No 3 (2023)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp25.3.2023.203-8

Varisela adalah penyakit menular yang disebabkan oleh virus varisela-zoster. Varisela merupakan penyakit endemik dengan tingkat penularan infeksi mencapai 90% pada kontak dekat. Prevalensi tertinggi terdapat pada kelompok usia 4-10 tahun. Neonatus yang lahir dari ibu yang memiliki varisela dan pasien imunokompromais, seperti keganasan, autoimun, penyakit ginjal kronis, dan pasca transplantasi organ padat (transplantasi hati/ginjal) rentan terhadap varisela-zoster . Kematian akibat varisela sangat jarang terjadi karena adanya program vaksin. Vaksin virus varisela hidup efektif untuk mencegah varisela (86%) dibandingkan dengan pasien yang tidak divaksinasi. Vaksin varisela dapat diberikan sebagai profilaksis sebelum dan setelah paparan. Asiklovir intravena dan Intravenous Immunoglobulin diindikasikan untuk diberikan pada neonatus yang lahir dari ibu yang memiliki varisela dan pasien imunokompromais.

H1N1pdm09 infection in children: A case report of reemerging disease in COVID-19 pandemic Puspaningtyas, Niken Wahyu; Nagrani, Dimple Gobind; Karyanti, Mulya Rahma; Fauzie, Rifan; Imanadhia, Ashfahani; Sarita, Raisa Cecilia; Putra, Reynaldo Rahima
Paediatrica Indonesiana Vol. 64 No. 4 (2024): July 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.4.2024.363-8

An outbreak of H1N1 infection was first declared by the World Health Organization in 2009 and confirmed in the post-pandemic phase in 2010. Amid the COVID-19 pandemic, we found a confirmed case of H1N1pdm09 in Bunda Women and Children Hospital Jakarta. A 13-year-old boy was referred to our hospital after four days of hospitalization due to worsening tachypnea following a productive cough and fever. The patient had severe dyspnea with inspiratory effort and oxygen desaturation to 80%, therefore admitted to our pediatric intensive care unit. On physical examination, the patient had increased work of breathing, looked irritable, had a respiratory rate of about 40x/minute with non-rebreathing mask support, and crackles were heard in both lungs. Chest x-ray showed right bronchopneumonia. There was a history of a generalized seizure for less than 1 minute, which stopped spontaneously in previous hospital care. The patient was diagnosed with mucopolysaccharidosis at age six years old and has never received enzyme replacement therapy. Laboratory results revealed thrombocytopenia, leukopenia, neutrophilia, monocytosis, high c-reactive protein and procalcitonin, and elevated liver enzymes. The investigation of etiology was performed using the respiratory panel test and showed a positive real-time polymerase chain reaction for H1N1pdm09 and Influenza A. The patient was given oxygen therapy with a high-flow nasal cannula with an oxygen fraction of 40% and a flow of 20 liters per minute, fluid maintenance while fasting, antibiotics, inhaled beta-2 agonists, and a neuraminidase inhibitor (oseltamivir). The patient's clinical and laboratory markers improved on the third day of treatment, and he was discharged two days later.

Community prevalence and distribution of dengue virus serotype based on antibody neutralization assay in Jakarta, Indonesia Karyanti, Mulya Rahma; Alam, Anggraini; Widyahening, Indah Suci; Hadinegoro, Sri Rezeki; Munasir, Zakiudin; Satari, Hindra Irawan; Sasmono, R. Tedjo
Paediatrica Indonesiana Vol. 65 No. 1 (2025): January 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.1.2025.10-6

Background Dengue infection is still rising globally despite the implementation of preventive efforts in many endemic countries. Monitoring the circulation of dengue virus (DENV) serotypes is not performed routinely in the Indonesian national surveillance program, primarily due to high cost and effort. Objective To evaluate the distribution of DENV serotypes based on serological profile and neutralizing antibody level against all four DENV serotypes in Jakarta, Indonesia. Methods This cross-sectional study was performed as part of a dengue vaccine effectiveness study, 10 years after a dengue vaccination program was initiated. It was conducted in five community public health centers in Jakarta in subjects aged 12 years and above who had not received the dengue vaccine. We collected serum samples and DENV neutralizing antibody titers were measured using a plaque reduction neutralization test (PRNT). Results Eighty healthy subjects with a median age of 15 (range 12-27) years were enrolled. The highest median antibody titer was that to DENV-2 [898 (range 29-91558) 1/dil], followed by that to DENV-3 [297.5 (range 10-36091); 1/dil], DENV-1 [288 (range 0-68237) 1/dil], and DENV-4 [164 (range 0-35812) 1/dil]. Neutralizing antibodies against the four DENV serotypes were found in all the 5 districts studied in Jakarta. A multitypic neutralizing antibody profile was observed in the majority (74/80 subjects; 92.5%). Three subjects were naïve. Conclusion All four dengue serotypes are widely circulating in Jakarta based on neutralizing antibody detection in the community, with the highest neutralizing antibody titer being against DENV-2, followed by DENV-3, DENV-1 and DENV-4.

Evaluasi Penggunaan Antibiotik dengan Seftriakson terhadap Kesembuhan Pasien Anak dengan Infeksi Saluran Kemih dan Pola Sebaran Bakteri Putri, Dewi Andini; Karyanti, Mulya Rahma; Tambunan, Taralan; Gayatri, Pramita; Bermanshah, Evita Karianni
Sari Pediatri Vol 26, No 5 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.5.2025.306-13

Latar belakang. Pemberian antibiotik yang rasional untuk infeksi saluran kemih (ISK) mendukung proses kesembuhan, mencegah komplikasi, dan mencegah resistensi antibiotik.Tujuan. Mengevaluasi penggunaan antibiotik dengan alur Gyssens, menilai kesembuhan subjek yang diberi antibiotik sesuai Pedoman Penggunaan Antibiotik (PPAB), dan mengetahui faktor-faktor risiko yang memengaruhi kesembuhan ISK.Metode. Penelitian deskriptif dengan desain potong lintang yang dilakukan secara retrospektif pada pasien anak dengan ISK yang dirawat di RSCM.Hasil. Alur Gyssens menunjukkan antibiotik diberikan rasional pada 53% pasien. Etiologi bakteri pada ISK tersering adalah Escherichia coli, Enterococcus faecalis, dan Klebsiella pneumonia. Kesembuhan ISK berhubungan dengan pemberian antibiotik sesuai rekomendasi PPAB dibandingkan dengan pasien yang diberikan antibiotik lain (88% vs 74%, p = 0,05). Faktor risiko yang terbukti memengaruhi kesembuhan ISK adalah jenis kelamin laki-laki (p=0,04, adjusted OR 2,1 (IK 95% 1,03-4,30)) dan kondisi pasien tanpa komorbiditas (p<0,01, adjusted OR 5,7 (IK 95% 1,64-20,05)).Kesimpulan. Terapi sesuai PPAB memberikan angka kesembuhan yang lebih tinggi dibanding terapi antibiotik lain.

Co-Authors Abdul Latief Agus Firmansyah Agus Firmansyah Amalia Almira Andi Annisa Rusyda Khafiyani Anggraini Alam, Anggraini Anis Karuniawati Annisa Putri Ari Prayitno Aryono Hendarto Athiyatul Aufie Bambang Supriyatno Bermanshah, Evita Karianni Dadi Suyoko Damayanti Rusli Sjarif Deasy Grafianti Delly Chipta Lestari Desti Handayani Dewi Kartika Suryani Dewi Murniati Oman Dina Muktiarti, Dina Dion Darius Samsudin Djajadiman Gatot Eka Laksmi Hidayati, Eka Laksmi Hanifah Oswari Hindra Irawan Satari Hindra Irawan Satari Hindra Irawan Satari Hindra Irawan Satari, Hindra Irawan I Wayan Gustawan Imanadhia, Ashfahani Indah S. Widyahening Irawan Mangunatmadja Irene Yuniar, Irene Karina Faisha Lucyana Alim Santoso Nabila Maudy Salma Nagrani, Dimple Gobind Nanda Asyura Rizkyani Nia Kurniati Nia Kurniati Nia Kurniati Nicolas Gunawan Nina Dwi Putri Novie Amelia Chozie Novie Homenta Rampengan Novie Homenta Rampengan Partini Pudjiastuti Trihono Partini Pudjiastuti Trihono, Partini Pudjiastuti Pinka Nurashri Setyati Pramita Gayatri Pramita Gayatri, Pramita Pratama Wicaksana Puspaningtyas, Niken Wahyu Putra, Reynaldo Rahima Putri, Dewi Andini Rahmadiena, Qonita Rahmah, Nailah Rahman, Himawan Aulia Rhodia, Lia Rifan Fauzie, Rifan Rizqi Amalia Rosalina Dewi Roeslani Rosyady, Maulana Sarita, Raisa Cecilia Sasmono, R. Tedjo Shahab, Muhammad Rayyan Faher Shindy Claudya Aprianti Soedjatmiko Sri Rezeki Hadinegoro Sri Rezeki Hadinegoro Sri Rezeki Hadinegoro Sri Rezeki Hadinegoro, Sri Rezeki Sri Rezeki S Hadinegoro Sri Sulastri Katarnida Sudung O Pardede, Sudung O Sukman Tulus Putra Tania Paramita Taralan Tambunan Taralan Tambunan Yessi Yuniarti Yoga Devaera Yudiyanto, Ade Rachmat Yusticia Katar Zakiudin Munasir

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