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All Journal Medical Journal of Indonesia Sari Pediatri Paediatrica Indonesiana Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute

Novie Amelia Chozie

Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia /Rumah Sakit Cipto Mangunkusumo, Jakarta

Author-ID : 3210751

Health Professions Medicine & Pharmacology Neuroscience Public Health

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Activation of coagulation system and d-dimer levels in children with acute leukemia Harun Wijaya; Novie Amelia Chozie; Badriul Hegar
Paediatrica Indonesiana Vol 54 No 4 (2014): July 2014
Publisher : Indonesian Pediatric Society

Background D-dimer is a molecule as result of breaking downof excessive fibrin formation from the activation of coagulationsystem. There is evidence of increased activation of coagulation inpatients with acute leukemia which was showed by the incrementof d-dimer levels.Objective To evaluate the incidence of activation of coagulationsys tem in children with acute leukemia before receivingchemotherapy.Method This cross-sectional study was performed at Dr. CiptoMangunkusumo Hospital. All newly-diagnosed children with acuteleukemia were included in this study, prior to their receiving anychemotherapy treatment. Blast count, prothrombin time (PTI),activated partial thromboplastin time (APTf), and D-dimer levelswere examined after the diagnosis was confirmed by morphology andimmunophenotyping studies on bone marrow specimens.Results Out of 22 subjects, 13 subjects had increased D-dimervalues. The median D-dimer level of this elevated group was 1,000(range 500-14, 700) n gfmL. In the acute myeloblastic leukemia(AML) patients, activation of coagulation was found in 7 out of 8subjects. The median D-dimer levels was 950 (range 100-14, 700)ng/mL. In the acute lymphocytic leukemia (ALL) patients, 6 outof 14 subjects had increased activation of coagulation with medianD-dimer level of 300 (range 100-3,800) ngfmL. Nine out of 10subjects with blast cells on peripheral blood smear had a medianD-dimer level of 1,000 (range 500-3,800) ng/mL. Both PT andAPTT were found normal in all subjects.Conclusion Activation of coagulation sys tem occurs at thetime of diagnosis as shown by increased D-dimer levels. Thecharacteristics of activation of coagulation system are differentbetween ALL and AML subjects, as well as between subj ects withpositive and negative blast counts on peripheral blood smears.Despite the increased activation of coagulation, PT and APTfremain normal.

Childhood non-Hodgkinâ€™s lymphoma in Cipto Mangunkusumo Hospital, Jakarta: Outcome of treatment 2000-2005 Djajadiman Gatot; Teny Tjitrasari; Novie Amelia Chozie
Paediatrica Indonesiana Vol 46 No 4 (2006): July 2006
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi46.4.2006.185-8

Background Childhood non-Hodgkinâ€™s lymphoma (NHL) is the thirdmost common solid tumor in Cipto Mangunkusumo, Jakarta. Since1992 there was no national report on the survival of children withNHL. To continue our observation on the result of treatment of chil-dren with NHL in our institution, we briefly report the outcome therapyof children with NHL who were admitted to our hospital during 2000-2005.Objective All patients who were diagnosed as non-Burkitt type NHLbetween January 2000-December 2005 were included in the study.Data collected retrospectively from the Oncology Registration ofHematology-Oncology Division, Department of Child Health, CiptoMangunkusumo Hospital, including age, sex, primary site of tumor,histopathology type, staging, treatment response, and outcome.Results A total of 24 patients were available. Male:female ratiowas 1.8:1. The age range was from 9 months to 11 years (median6 years). The histological type consisted of LL (3) and non-LL (11).Ten out of 14 patients were diagnosed as advanced stages (stagesIII and IV), while the rest were in stage II. Primary tumor site in LLtype were the head and neck (1), mediastinum (1), and testis (1),while the non-LL type patients had more varied site. Overall sur-vival of NHL was 78.6%+4.7%.Conclusion The overall survival of childhood NHL patients treatedwith protocol in our institution is in the range of survival that hadachieved in other centers worldwide, even with advanced stage ofdisease.

Hemostatic abnormalities in children with thalassemia major and liver iron overload Pustika Amalia Wahidiyat; Stephen Diah Iskandar; Novie Amelia Chozie; Damayanti Sekarsari
Paediatrica Indonesiana Vol 58 No 4 (2018): July 2018
Publisher : Indonesian Pediatric Society

Background Thalassemia major (TM) patients are susceptible to liver dysfunction due to iron deposition. Pediatric TM patients often present with bleeding. Blood loss necessitates transfusions, leading to increased iron absorption from the gut. Objective To study hemostatic abnormalities in children with TM and iron deposition in the liver. Methods This cross-sectional study involved 190 non-splenectomized children with TM. Liver iron deposition was evaluated using T2* MRI. Prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet counts were assessed from blood specimens. Results Most subjects were diagnosed with Î²-thalassemia and Î²-thalassemia/HbE. The majority of subjects were on deferiprone (DFP) treatment. Approximately 89.5% of subjects had liver iron overload. Prolongation of PT and aPTT, as well as thrombocytopenia were observed in 60%, 27.9%, and 19.5% of subjects, respectively. Prolonged aPTT and thrombocytopenia were observed three times more frequently in subjects with moderate - severe liver iron overload than in subjects with normal - mild liver iron overload (P=0.04 and 0.001, respectively). Conclusion Most TM subjects have liver iron overload ranging from mild to severe. Prothrombin time and prolongation, as well as aPTT prolongation, and thrombocytopenia are easily found in TM children. There were significantly more moderate - severe liver iron deposition patients with aPTT prolongation and thrombocytopenia than normal â€“ mild patients with these conditions. Hence, we suggest that pediatric TM patients undergo liver iron deposition evaluations and use iron chelators in an optimal manner, in order to limit the risk of bleeding.

Short-term intermittent prophylaxis post-intracranial hemorrhage in children with hemophilia Novie Amelia Chozie; Fitri Primacakti; Made Citra Saraswati; Damayanti Sekarsari
Paediatrica Indonesiana Vol 62 No 3 (2022): May 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.3.2022.174-9

Background Intracranial hemorrhage (ICH) is one of the major bleeding events causing mortality and long-term morbidity in children with hemophilia, especially those who receive on-demand therapy. Objective To evaluate the outcome of children with hemophilia after ICH receiving short-term intermittent prophylactic treatment. Methods This retrospective study was conducted in the Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta. Children £18 years of age with hemophilia presenting with ICH between 2015-2020 were included. We recorded patients’ demographics, type and severity of hemophilia, the presence of factor VIII (FVIII) inhibitor, brain CT scan, treatment, and outcomes of these patients. Patients who received short-term intermittent prophylaxis using clotting factor concentrate (CFC) post-ICH episodes were observed for ICH recurrence. Results There were 19 episodes of ICH experienced by 18 patients, consisting of 16 patients with hemophilia A and 2 with hemophilia B. Patients’ median age was 4 years (range 0-16 years). Hemophilia was classified as severe in 13 patients, moderate in 4 patients, and mild in 1 patient. Thirteen episodes were preceded by head trauma. The most common clinical manifestation was seizures (13.2%). The most common type of ICH was subdural hematoma. Two patients died and 2 patients had neurological sequelae during hospitalization. The median dose of short-term intermittent prophylaxis using CFC (n=16) was 20 IU/kg of FVIII twice a week and 30 IU/kg of FIX twice a week, for a median duration of 8 weeks (range 5-12 weeks). One patient who did not adhere to the prophylaxis regimen had recurrent ICH at a similar location 6 months after the first episode. Conclusion Our findings suggest that short-term intermittent prophylaxis is important to prevent the recurrence of ICH in children with hemophilia.

Translation, cultural adaptation, and validation of the Indonesian version of Pediatric Quality of Life Inventory Rheumatology Module (PedsQL-RM) questionnaire for children with rheumatic diseases Ganda Ilmana; Zakiudin Munasir; Novie Amelia Chozie; Bernie Endyarni Medise
Paediatrica Indonesiana Vol 63 No 3 (2023): May 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.3.2023.136-45

Background Quality of life is an important outcome in the management of children with chronic conditions such as rheumatic diseases. The Pediatric Quality of Life Inventory Rheumatology Module (PedsQL-RM) questionnaire has been proven valid and reliable, but a validated Indonesian version of the questionnaire is not yet available. Objective To translate the PedsQL-RM into the Indonesian language, perform a transcultural adaptation, and assess its validity. Methods A cross-sectional study was performed in patients aged 2 to 18 years with systemic lupus erythematosus (SLE) or juvenile idiopathic arthritis (JIA) in Dr. Cipto Mangunkusumo Hospital, Jakarta. The initial phase of the study consisted of forward translation from the original English version into Indonesian, synthesis by experts, backward translation, and cognitive debriefing, resulting in the final version of the questionnaire. The second phase was testing the final questionnaire on patients in each age group and their parents. Tests were carried out in two sessions with an interval of 2 to 4 weeks. The questionnaire consisted of a child report and a parent report, each measuring five dimensions: pain and hurt, activities, treatment, worry, and communication. We subsequently assessed validity and reliability of each dimension in the child and parent reports for the child and teen age groups. Validity was expressed as correlation coefficient (r) between dimension scores with the total score. Results The finalized Indonesian questionnaire was completed by 53 children aged 2-18 years with SLE or JIA and their parents. Due to small numbers of subjects in the younger age ranges, analysis was only performed in the 8-to-18-year age group. Validity varied from good to very good (r = 0.437 to 0.910) for the child report and from poor to good (r = 0.153 to 0.808) for the parent report. The questionnaire was deemed reliable, with a Cronbachâ€™s alpha of 0.755 to 0.785. Conclusion The Indonesian version of the PedsQL-RM is valid and reliable for assessing quality of life in children aged 8 to 18 years with rheumatologic disease. Further study is needed to assess the validity and reliability of the tool for children aged 2 to 7 years.

Effects of the COVID-19 pandemic on emotional and behavioral problems and sleep problems in adolescents Medise, Bernie Endyarni; Reza, Maulana Okta; Devaera, Yoga; Soebadi, Amanda; Chozie, Novie Amelia; Pudjiadi, Antonius H
Paediatrica Indonesiana Vol. 63 No. 5 (2023): September 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.5.2023.383-8

Background The asynchrony rapid phase of cognitive, physical and emotional development occurring in adolescence may result in various issues such as risk-taking behavior, psychosocial and emotional problems. School closure during the COVID-19 pandemic has caused a tremendous change in adolescent lifestyle and habits, including sleep patterns. causing added challenges to adolescents’ emotional and behavioral problems. Objective To identify the association between sleep disorders with emotional and behavioral problems during the COVID-19 pandemic in urban and rural adolescents. Methods We conducted a cross-sectional study among adolescents aged 12-18 years from November to December 2021 in two provinces, DKI Jakarta and Riau Islands. We recruited students consecutively from randomly selected junior and senior high schools. We used the Strengths and Difficulties Questionnaire (SDQ) and the Pittsburgh Sleep Quality Index (PSQI) to screen for emotional and behavioral problems and for sleep disorders, respectively. The questionnaires were sent electronically to each subject after obtaining parental consent. Results There were 400 subjects included in our study, of which 64% were female. The prevalences of COVID-19 amongst subjects in urban and rural areas were COVID-19 12.5% and 5.5%, respectively. Emotional and behavioral disorders as well as sleep disorders were more common in rural than urban areas (13 vs. 11.5% and 50.5% vs. 38%; P=0.012, respectively). Sleep disorders were associated with the SDQ subscales of emotional symptoms [PR 4.88 (95%CI 2.97 to 8.03); P<0.01), conduct problems [PR 3.71 (95%CI 1.53 to 9.04); P=0.02), hyperactivity/inattention [PR 6.05 (95%CI 2.58 to 16.17); P<0.01], and peer relationship problems [PR 3.28 (95%CI 1.33 to 8.09); P<0.01). Conclusion Sleep disorders among adolescents during COVID-19 pandemic were associated with emotional and behavioral problems. Adolescents who live in rural areas were more likely to have sleep disorders, emotional and behavioral problems.

Clot waveform analysis to differentiate mild, moderate, and severe hemophilia A Timan, Ina Susianti; Chozie, Novie Amelia; Santoso, Novianti
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/pi64.4.2024.325-31

Background Clot waveform analysis can be used to evaluate clot formation profiles. This waveform can be obtained from activated partial thromboplastin time (APTT) assays without additional reagents and shows different patterns in hemophilia patients with coagulation factor VIII (F VIII) deficiency or abnormality. Objective To determine the clot wave pattern and its process in clot formation phases (pre-coagulation, coagulation, and post-coagulation) in normal and hemophilia A subjects, analyze for possible correlations between clot wave parameters and F VIII activity, and obtain the pattern of coagulation curves in hemophilia subjects as a step to assess clot waveform analysis as a possible screening tool for hemophilia. Methods In this cross-sectional study, we performed clot wave analysis in 145 adult and pediatric subjects with hemophilia to obtain the clot wave pattern in this condition. Clot wave analysis was also done in 160 subjects with normal hemostasis to obtain reference clot wave parameters. Results In this study, the starting point of coagulation phase in normal subjects was between 30-40 seconds, with a shorter pre-coagulation phase and steeper slope. Hemophilia patients had a longer pre-coagulation phase and flatter slope, especially in severe hemophilia A patients, who had longer and more variable coagulation starting points (P<0.001). The absolute values of maximum coagulation velocity (Min1), maximum coagulation acceleration (Min2), and maximum coagulation deceleration (Max2) of hemophilia A patients were also lower than those of normal hemostasis patients, with lower absolute value seen in severe than in mild-moderate hemophilia A patients. A moderate correlation was found between Min1, Min2, and Max2 with F VIII activity (P<0.001). Conclusion Clot wave analysis may be considered as a method for screening hemophilia patients to distinguish mild-moderate and severe hemophilia A patients in health facilities that lack the ability to perform F VIII assays.

Bleeding outcomes and musculoskeletal function in adolescents having severe hemophilia A: a case series Primacakti, Fitri; Prasetyo, Marcel; Fauzia, Sri Novia; Sarita, Raisa Cecilia; Chozie, Novie Amelia
Paediatrica Indonesiana Vol. 65 No. 3 (2025): May 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.3.2025.268-72

As an emerging country, Indonesia is still in the process of implementing prophylaxis as a standard of care for managing hemophilia with limited real-world evidence in Indonesian patients. This case series details the effects of tertiary prophylaxis with an intermediate dose of factor VIII concentrate on bleeding outcomes and musculoskeletal function in three Indonesian adolescents suffering from severe haemophilia A and associated arthropathy.

Predictors of pediatric Henoch-Schönlein purpura recurrence Santoso, Dara Ninggar; Kurniati, Nia; Hendarto, Aryono; Chozie, Novie Amelia; Prawira, Yogi; Marsubrin, Putri Maharani Tristanita
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.307-15

Background Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children and is usually self-limited with a favorable prognosis. However, recurrence in children is associated with a poorer prognosis, i.e., a higher risk of progressing to chronic kidney disease (CKD) as a long-term complication. In Indonesia, the recurrence rate of HSP and its predictors in children have not been well established . Objective To estimate the incidence of recurrent HSP and determine its predictors in children at Dr. Cipto Mangunkusumo National General Hospital (RSCM). Methods A retrospective cohort review of medical records followed children aged <18 years at RSCM for 6 months after HSP diagnosis based on the the European League Against Rheumatism (EULAR)/ Paediatric Rheumatology European Society (PRESS)/Paediatric Rheumatology International Trials Organization (PRINTO) criteria. Multivariate, Cox logistic regression, and Kaplan-Meier analyses were performed. Results This study included 116 children aged 2–17 years with HSP. Twenty-six (22.4%) of the subjects experienced recurrence, with an incidence of 3.56 per 100,000 person-years. The only statistically significant predictor for recurrence was the presence of infection after the first episode of HSP (HR 11.301; 95%CI 4.327 to 29.519; P<0.001). The cumulative survival of subjects with infection for recurrence over 6 months was 51%, with mean 5.3 months survival duration (95%CI 4.76 to 5.99; P< 0.0001). Chronic kidney disease, a long-term complication of HSP, was noted in 22 (19%) participants. Conclusion Recurrence of HSP was observed in 22.4% of our subjects within 6 months follow up. However, subjects with a history of infection after their first episode of HSP resolution should be notified about the possibility of recurrence. Chronic kidney disease occurred in 22 participants (19%), possibly becoming a long-term complication of HSP.

Antibiotic use in children before and after an e-learning intervention Rosyady, Maulana; Karyanti, Mulya Rahma; Chozie, Novie Amelia
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/pi65.5.2025.373-81

Background Antibiotic resistance is a global health threat. E-learning can be used to increase the knowledge of medical staff and the effectiveness of antibiotic use. Objective To evaluate the impact of e-learning intervention for pediatric doctors and residents on antibiotic use in pediatric patients. Methods This single-arm intervention study involved all pediatric doctors and residents from the Department of Child Health, Faculty of Medicine at Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital (FMUI-CMH). Staff and residents underwent e-learning intervention on the topic of antimicrobial stewardship (AMS) via the E-learning Management System Universitas Indonesia (EMAS UI) website, followed by comparison of their pre- and post-intervention knowledge. The appropriate use of antibiotics pre- and post-intervention at October and December 2022, respectively, by was assessed by Gyssen's flowchart. Results A total of 135 (54.4%) antibiotic uses in the pre-intervention period and 170 (72.24%) in the post-intervention period were considered appropriate. A significantly greater proportion of subjects received appropriate antibiotic use after the intervention compared to before (95%CI 0.363 to 0.795; P=0.002). Forty-two out of 56 pediatricians and 119 out of 123 pediatric residents participated in the e-learning program. There was a significant improvement in knowledge levels between the pre- and post-intervention periods among pediatricians, with more passing the post-intervention assessment compared to the pre-intervention assessment (1 vs. 29, respectively; P=0.001). Similarly, a significant increase was observed among pediatric residents (10 vs. 66, respectively; P=0.001). Conclusion There was a significant increase in appropriate antibiotic use in pediatric patients at CMH after pediatric doctors and residents underwent e-learning interventions.

Co-Authors Abigail, Dina Clarisa Rumora Antonius H Pudjiadi, Antonius H Aryono Hendarto Atmakusuma, Tubagus Djumhana Badriul Hegar Bernie Endyarni Medise Bidasari Lubis Candini, Naura Anindya Damayanti R. Sjarif Damayanti Sekarsari Djajadiman Gatot Djajadiman Gatot Djajadiman Gatot Fauzia, Sri Novia Fitri Primacakti Fitri Primacakti, Fitri Ganda Ilmana Harun Wijaya Ina Susianti Timan Joedo Prihartono Made Citra Saraswati Marcel Prasetyo Marsubrin, Putri Maharani Tristanita Mulya Rahma Karyanti, Mulya Rahma Murti Andriastuti, Murti Nadia Devina Esmeralda Nia Kurniati Pustika Amalia Wahidiyat Pustika Amalia Wahidiyat, Pustika Amalia Raisa Cecilia Sarita Ramadhani, Nadhifa Tazkia Reza, Maulana Okta Rosyady, Maulana Santoso, Dara Ninggar Santoso, Novianti Saraswati, Made Citra Sarita, Raisa Cecilia Setyanto, Darmawan Budi Soebadi, Amanda Stephen Diah Iskandar Sukartini, Ninik Syahminar Rahmani Teny Tjitra Sari, Teny Tjitra Teny Tjitrasari Wiharta, Fitri Primacakti Yoga Devaera, Yoga Yogi Prawira, Yogi Yuniasti Evitasari Zakiudin Munasir

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