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All Journal Medical Journal of Indonesia Sari Pediatri Paediatrica Indonesiana International Archives of Medical Sciences and Public Health 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
Religion Environmental Science Health Professions Medicine & Pharmacology Neuroscience Public Health

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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

Abstract

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.
Emicizumab prophylaxis in severe hemophilia A with inhibitor: impact on quality of life and musculoskeletal outcomes Wiharta, Fitri Primacakti; Saraswati, Made Citra; Abigail, Dina Clarisa Rumora; Chozie, Novie Amelia
Medical Journal of Indonesia Vol. 34 No. 3 (2025): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.cr.257819

Abstract

Emicizumab has been acknowledged for its effectiveness in preventing bleeding in patients with hemophilia A developing inhibitors. This report examined the impact of emicizumab prophylaxis on health-related quality of life (HRQoL) and musculoskeletal outcomes in a 10-year-old male with severe hemophilia A and a high titer of factor VIII (FVIII) inhibitor, presenting with hemophilic arthropathy on the right knee and left elbow. He had been unable to walk and was previously treated on-demand with a plasma-derived FVIII concentrate. He received emicizumab prophylaxis for 16 months. HRQoL was evaluated using a hemophilia-specific questionnaire, while musculoskeletal outcomes were assessed using hemophilia early arthropathy detection with ultrasound (HEAD-US) and the hemophilia joint health score (HJHS). During treatment, no breakthrough bleeding occurred, and the patient regained the ability to walk. Emicizumab prophylaxis significantly improved in HRQoL, especially in physical health and sports and and school domains, aligning with bleeding rates, HEAD-US, and HJHS assessments.
Association between Musculoskeletal Status and Genetic Mutations in Patients with Hemophilia A Primacakti, Fitri; Wahidiyat, Pustika Amalia; Sjarif, Damayanti R.; Chozie, Novie Amelia; Candini, Naura Anindya; Prihartono, Joedo; Sukartini, Ninik; Ramadhani, Nadhifa Tazkia; Lubis, Bidasari
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 9 No. - (2025): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v9i-.316

Abstract

Introduction: Hemophilia A is an inherited bleeding disorder caused by mutations in the factor VIII (FVIII) gene. These mutations result in either reduced FVIII synthesis (null variants) or loss of FVIII function (non-null variants). Null variants are typically associated with more severe FVIII deficiency and recurrent joint bleeding, which may adversely affect musculoskeletal health.  Objective: To evaluate the relationship between musculoskeletal status and genetic mutations in patients with hemophilia A. Methods: A cross-sectional study was conducted at the Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo Hospital from June 2024 to March 2025. Genetic analysis was performed at the Human Genetic Research Center using inverse-shifting PCR and Sanger sequencing. Mutations were classified as null variants (intron-22 inversion, intron-1 inversion, large deletion, and nonsense mutations) and non-null variants (missense and non-conserved splice mutation). Musculoskeletal status was assessed by the presence of target joints and the Hemophilia Joint Health Score (HJHS), which evaluates global gait and joint function of the elbows, knees, and ankles. Higher HJHS scores indicate worse joint health.  Results: Sixty patients were included in this study, of which 39 had severe, 15 had moderate, and the remaining 6 had mild hemophilia A. The median age was 9.5 years (range 2-18). Null variants were identified in 45/60 patients and non-null variants in 15/60 patients. The most common target joints were the knees in patients with null variants and the ankles in those with non-null variants. The median HJHS was 4 (Q1-Q3: 2-13.5) in the null variant group and 2 (Q1-Q3: 1-11) in the non-null variant group. No significant association was observed between the target joint and the HJHS and genetic mutations. Further subgroup analysis showed no difference in HJHS between mutation groups among patients receiving prophylaxis (p=0.366) or on-demand treatment (p=0.458). Conclusion: No association was found between genetic mutation type and musculoskeletal status in patients with Hemophilia A. HJHS did not differ between mutation groups regardless of treatment regimens.  
Clinical characteristics and genetic mutations in hemophilia A patients with inhibitors Fitri Primacakti; Pustika Amalia Wahidiyat; Damayanti Rusli Sjarif; Novie Amelia Chozie; Ninik Sukartini; Joedo Prihartono; Sheila Claudhea Salsabila; Nadhifa Tazkia Ramadhani; Bidasari Lubis
Paediatrica Indonesiana Vol. 66 No. 1 (2026): January 2026
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background Antibodies to factor VIII, known as inhibitors, are a major problem in hemophilia A, especially in severe cases. Certain genetic mutations are associated with a higher risk of the formation of inhibitors. This study is the first in Indonesia to report on genetic mutations of hemophilia A patients with inhibitors. Objectives To detect genetic mutations, investigate potential risk factors, and evaluate inhibitor prevalence in pediatric hemophilia A patients. Methods An observational study was conducted at the Pediatric Hemophilia Treatment Center of Cipto Mangunkusumo Hospital, Jakarta. Inhibitors were measured using the Bethesda assay and classified as low- or high titer. Inverse shifting polymerase chain reaction (IS-PCR) was performed to detect inversion mutations. Negative results for inversion were followed by Sanger sequencing. Clinical data were obtained from medical records. Results Inhibitors were detected in 17 of 114 hemophilia A patients (14.9%), most of whom (88.2%) had severe disease and had fewer than 150 days of exposure to clotting factor concentrates (CFCs), classifying them as previously untreated patients (PUPs). The genetic mutations identified in inhibitor patients were intron 22 inversion (INV-22) mutations (41.2%), intron 1 inversion (INV-1) mutations (29.4%), nonsense mutations (17.6%), large deletions (5.9%), and missense mutations (5.9%). Family history of inhibitors, previous intensive treatment for major bleeding events or surgery, and type of concentrate were potential risk factors. Conclusion Intron 22 inversion mutations were the most common mutations associated with the presence of inhibitors in hemophilia A patients.
PRESEPSIN AS A POTENTIAL BIOMARKER OF SEPSIS IN PEDIATRIC PATIENTS UNDERGOING OPEN-HEART SURGERY Julia Fitriany; Mulyadi M Djer; Novie Amelia Chozie; Piprim Basarah Yanuarso; Nina Dwi Putri; Irene Yuniar
International Archives of Medical Sciences and Public Health Vol. 7 No. 1 (2026): International Archives of Medical Sciences and Public Health
Publisher : Pena Cendekia Insani

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53806/iamsph.v7i1.1418

Abstract

Sepsis after pediatric open-heart surgery is rare but highly lethal. Diagnosis is challenging because sepsis symptoms often overlap with post operative inflammatory responses. This study assessed presepsin as a biomarker for postoperative sepsis in children with congenital heart disease. In this prospective diagnostic accuracy study at Cipto Mangunkusumo National Central Hospital, Jakarta, 49 children undergoing open-heart surgery were enrolled. Plasma presepsin and procalcitonin (PCT) levels were measured on postoperative day 1 (T1) and day 3 (T3). Diagnostic performance was evaluated using ROC analysis. Presepsin levels were higher in septic than non-septic patients at T1 (415 vs. 141.5 pg/mL) and T3 (624 vs. 75.9 pg/mL), with a significant difference at T3 (p = 0.001). Presepsin was unrelated to surgical complexity but was associated with 7-day mortality (p = 0.013). At T3, presepsin showed better diagnostic accuracy than PCT (AUC 0.945 vs. 0.895). Optimal cutoffs were 404 pg/mL (T1) and 203.5 pg/mL (T3). PCT levels declined over time in septic patients. Presepsin is a promising biomarker for detecting postoperative sepsis in pediatric open-heart surgery patients, demonstrating diagnostic performance comparable to or superior to PCT, particularly on postoperative day 3. Serial monitoring may facilitate earlier identification of septic complications.
Co-Authors Abigail, Dina Clarisa Rumora Amanda Soebadi Antonius H. Pudjiadi Aryono Hendarto Atmakusuma, Tubagus Djumhana Badriul Hegar Bernie Endyarni Medise Bidasari Lubis Bidasari Lubis Damayanti R. Sjarif Damayanti Rusli Sjarif Damayanti Sekarsari Djajadiman Gatot Djajadiman Gatot Djajadiman Gatot Djajadiman Gatot Dwikinta, Made Anindya Eka Laksmi Hidayati, Eka Laksmi Endang Windiastuti Endang Windiastuti Evita Kariani B. Ifran Fauzia, Sri Novia Fitri Primacakti, Fitri Ganda Ilmana Gitta Cempako Harun Wijaya Idham Amir Ina Susianti Timan Irene Yuniar Joedo Prihartono Joedo Prihartono Julia Fitriany Made Citra Saraswati Marcel Prasetyo Meida Tanukusumah Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Munasir, Zakiudin Murti Andriastuti, Murti Nadhifa Tazkia Ramadhani Nadia Devina Esmeralda Nathanne Septhiandi Nia Kurniati Nia Kurniati Nina Dwi Putri Ninik Sukartini Partini P Trihono Piprim B Yanuarso Piprim Basarah Yanuarso, Piprim Basarah Pustika Amalia Wahidiyat Pustika Amalia Wahidiyat, Pustika Amalia Putri Maharani Tristanita Marsubrin Raisa Cecilia Sarita Ramadhani, Nadhifa Tazkia Reza, Maulana Okta Rismala Dewi Rosyady, Maulana Santoso, Dara Ninggar Santoso, Novianti Saraswati, Made Citra Sarita, Raisa Cecilia Setyanto, Darmawan Budi Setyo Handryastuti Sheila Claudhea Salsabila Stephen Diah Iskandar Syahminar Rahmani Teny Tjitra Sari, Teny Tjitra Teny Tjitrasari Yoga Devaera Yogi Prawira Yuniasti Evitasari