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All Journal Sari Pediatri Paediatrica Indonesiana Jurnal Respirologi Indonesia Oto Rhino Laryngologica Indonesiana Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Narra J Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Junior Medical Journal
Irawan Mangunatmadja
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia Jakarta
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Dampak COVID-19 pada Anak dengan Epilepsi: Perspektif Orangtua dan Pengasuh Setyo Handryastuti; Irawan Mangunatmadja; Amanda Seobadi; Asep Aulia Rachman; Iqbal Taufiqqurrachman; Achmad Rafli
Sari Pediatri Vol 24, No 4 (2022)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp24.4.2022.232-8

Abstract

Latar belakang. Pandemi coronavirus disease 2019 (COVID-19) yang disebabkan severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) telah memengaruhi pelayanan kesehatan. Hal ini dapat berdampak pada keterlambatan diagnosis dan terapi termasuk pelayanan kesehatan pada anak dengan epilepsi. Hal ini menimbulkan risiko anak dengan epilepsi tidak mendapatkan pelayanan kesehatan yang optimal yang dapat menyebabkan kambuhnya kejang dan penurunan kualitas hidup anak dengan epilepsi.Tujuan. Untuk mengetahui dampak COVID-19 terhadap pelayanan kesehatan anak dengan epilepsi dari perspektif orangtua atau pengasuh.Metode. Penelitian deskriptif dilakukan dengan metode potong lintang. Sampel diperoleh dengan metode survei wawancara langsung menggunakan kuesioner yang terdiri dari 23 pertanyaan pada bulan Februari-April 2022 kepada 252 orangtua/pengasuh yang berasal dari beberapa rumah sakit besar dan klinik di Jakarta.Hasil. Sebagian besar pasien tidak memiliki masalah perilaku (58,3%), tidak terdapat gangguan tidur (59,1%) serta tidak terdapat perubahan kepatuhan berobat (63,1%).Mayoritas pasien tidak pernah mendapat terapi diazepam rektal untuk mengatasi kekambuhan kejang (61,9%) selama pandemi. Masalah terbesar bagi orang tua dan pengasuh adalah rasa takut mengunjungi rumah sakit (27,4%%) dan lebih memilih untuk berkonsultasi secara langsung (86,9%) dibandingkan telekonsultasi atau tidak kontrol. Manfaat telekonsultasi bervariasi, antara lain, penurunan kebutuhan pergi keluar rumah (24,7%), hemat waktu (28,6%), dan menurunkan biaya transportasi (28,6%). Terdapat beberapa kekurangan telekonsultasi, yaitu miskomunikasi antara dokter dan pasien (39,4%). Kualitas pelayanan poliklinik neurologi masih cukup baik (68,3%), dengan pelayanan elektroensefalografi dan perawatan rehabilitasi selama pandemi masih berjalan seperti biasa (96% dan 46%). Sekitar 45,2% orang tua dan pengasuh setuju bahwa anak perlu divaksinasi, meskipun baru 22,2% dari seluruh subyek telah memperoleh vaksinasi.Kesimpulan. Pandemi COVID-19 tidak hanya berdampak pada manusia, melainkan juga pada sistem pelayanan kesehatan khususnya anak dengan epilepsi. Oleh karena itu, modifikasi pelayanan kesehatan selama pandemi COVID-19 merupakan kunci untuk mempertahankan kualitas pelayanan anak dengan epilepsi seperti, telekonsultasi.
Accuracy of behavioral responses in early detection of autism spectrum disorders in children aged 18 months to 4 years with speech delay Danu, Nugroho; Handryastuti, Setyo; Mangunatmadja, Irawan; Pusponegoro, Hardiono D.
Paediatrica Indonesiana Vol. 64 No. 1 (2024): January 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.1.2024.17-21

Abstract

Background Early detection of autism spectrum disorders (ASD) in children with speech delay is important to improve outcomes. Behavioral responses to calling, teasing, poking, and blocking can be used to screen for ASD in daily practice. Objective To evaluate the accuracy of behavioral responses to stimuli in detecting ASD in children aged 18 months to 4 years with speech delay. Methods This cross-sectional study was conducted in children with speech delay aged 18 months to 4 years who visited the Outpatient Clinic of Cipto Mangunkusumo Hospital, Jakarta. Subjects were stimulated while playing by poking, teasing, calling, and blocking (stopping the child’s play using the examiner’s hand) and were assessed for their responses. Lack of seeking eye contact with the examiner following the stimulus was considered as a response suggestive of ASD. Independent diagnosis based on DSM-V criteria was considered the gold standard to diagnose ASD or non-ASD. Results A total of 109 children were included in this study, with an average age of 32 (SD 7.4) months. There were 52 subjects (47.7%) with ASD and 57 subjects (52.2%) with non-ASD. Behavioral response analysis revealed that calling, blocking and teasing had high sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying ASD. The poking response had the highest specificity to rule out ASD compared to other stimuli, with 75% sensitivity (95%CI 63.2% to 86.7%), 93% specificity (95%CI 86.3% to 99.6%), 90% PPV (95%CI 82% to 99.3%), and 80% NPV (95%CI 70.7% to 89.9%). When all behavioral responses were combined, with lack of a response to all four stimuli considered suggestive of ASD, we obtained 100% specificity, 42% sensitivity, 100% PPV and 65% NPV. Conclusion The combination of behavioral responses had high specificity, sensitivity, PPV, and NPV for early detection of ASD in children with speech delay.
Role of antioxidants in reducing oxidative stress and seizure frequency in drug-resistant epileptic patients Ismy, Jufitriani; Soebadi, Amanda; Mangunatmadja, Irawan; Monica, Merci; Sari, Teny T.; Yuliarti, Klara
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.v4i2.790

Abstract

Drug-resistant epilepsy presents significant challenges in treating epileptic patients, leading to recurrent seizures and necessitating the use of polypharmacy with anti-epileptic drugs. Both of these conditions contribute to increased oxidative stress, which is detrimental to the brain. The aim of this study was to determine the role of vitamins C and E in reducing oxidative stress and seizure frequency in drug-resistant epileptic patients. This was a double-blinded, randomized clinical trial with a placebo, parallel design, and block randomization. The subjects were drug-resistant epileptic patients aged 1–18 years who received routine treatment. Randomization was performed on 100 patients who were divided into the treatment or placebo groups. The patients received a combination of vitamin C (100 mg/day) and vitamin E (200 IU/day for those <5 years or 400 IU/day for those ≥5 years) or a placebo for eight weeks. Malondialdehyde (MDA) levels and seizure frequency were measured prior to and after the intervention. A total of 42 and 46 patients were followed till the end of the study in the intervention and placebo groups, respectively. Our data indicated that the MDA levels prior to treatment were not significantly different between the treatment and placebo groups (0.901 vs 0.890 mmol/mL, p=0.920) and were significantly reduced after the treatment in both the treatment group (p<0.001) and placebo group (p=0.028). The changes in MDA levels (between post- and pre-treatment) were also not significantly different between the two groups (p=0.181). Our per-protocol analysis indicated that the reduction in seizure frequency was significantly higher in the treatment group compared to the placebo group (95% vs 35%, p<0.001), with 92% and 60% relative and absolute risk reduction, respectively. The intention-to-treat analysis also indicated that the reduction in seizure frequency was significantly higher in the intervention group than in the control group (80% vs 32%, p<0.001), with relative and absolute risk reduction of 70% and 48%, respectively. There was no significant relationship between changes in MDA levels and seizure frequency in either group. In conclusion, vitamins C and E could reduce seizure frequency and, therefore, could be considered as adjuvant therapy in drug-resistant epileptic patients.
Hubungan antara Status Gizi dengan Tingkat Perkembangan Anak yang Teridentifikasi Stunting di Wilayah Jakarta Selatan Tahun 2022 Tuty; Mangunatmadja, Irawan
Junior Medical Journal Vol. 2 No. 2 (2023): Oktober 2023
Publisher : Fakultas Kedokteran Universitas YARSI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33476/jmj.v2i2.3997

Abstract

Stunting merupakan salah satu faktor risiko yang kuat terhadap keterlambatan perkembangan. Gangguan perkembangan bersifat multifaktorial tetapi saat ini belum terdapat hubungan yang jelas antara perkembangan dengan status gizi. Melalui studi ini, peneliti ingin melihat hubungan antara status gizi dan perkembangan pada anak usia balita. Penelitian potong lintang pada anak berusia kurang dari 5 tahun dengan stunting dilakukan pada 9 Puskesmas di Jakarta Selatan sejak Januari hingga Juli 2022. Pada subjek dilakukan pengukuran antropometri dan pemeriksaan perkembangan menggunakan Ages and Stages Questionnaires (ASQ) versi 3. Status gizi pasien diolah menggunakan aplikasi WHO antropometri dan analisis data menggunakan SPSS. Terdapat 136 subjek yang sesuai dengan kriteria inklusi, dengan total subjek akhir didapatkan 100 subjek. Karakteristrik demografi subjek sedikit didominasi jenis kelamin perempuan (51%), median usia subjek adalah 34 bulan berkisar antara 5 – 56 bulan, dan status gizi didominasi gizi baik (60%). Perkembangan yang tidak normal didapatkan pada 64 subjek (64%) dengan keterlambatan perkembangan global pada 29% subjek. Tidak terdapat hubungan yang signifikan antara status gizi dengan gangguan perkembangan pada subjek (p = 0,598). Terdapat hubungan yang signifikan antara nilai Z-score Weight-for-Height (WHZ) dengan aspek perkembangan komunikasi (p = 0,07) dan motorik kasar (p = 0,015). Status gizi tidak memengaruhi keterlambatan perkembangan secara keseluruhan tetapi memiliki hubungan dengan aspek komunikasi dan motorik kasar. Studi lebih lanjut mengenai status gizi dan tingkat perkembangan perlu dilakukan.
Lennox-Gastaut syndrome and its impact on quality of life: hearing and speech perspective Zizlavsky, Semiramis; Putri, Shally Adhina Adhina; Pamungkas, Indra Parmaditya; Anam, Khoirul; Mangunatmadja, Irawan
Oto Rhino Laryngologica Indonesiana Vol. 52 No. 1 (2022): VOLUME 52, NO. 1 JANUARY - JUNE 2022
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v52i1.549

Abstract

ABSTRACTBackground: Lennox-Gastaut syndrome (LGS) is a severe pediatric epilepsy syndrome characterized by multiple seizure types including tonic, atonic, atypical absence, and generalized tonic-clonic seizures. LGS is also associated with cognitive decline and various neural disturbance, including hearing loss. Purpose: To report a case of Lennox-Gastaut syndrome with unilateral hearing loss and delayed speech. Case report: Four years old boy with LGS and delayed speech was referred to the Otolaryngology Outpatient Clinic, Dr Cipto Mangunkusumo Hospital for hearing and speech ability evaluation. He had had repeated seizures since he was three weeks old, and also had cortical lesion and mild atrophy in the left hemisphere brain. Hearing tests with Otoacoustic Emission (OAE), Brainstem Evoked Response Audiometry (BERA), and Auditory Steady State Response (ASSR) revealed profound unilateral hearing loss in the left ear, which required hearing aid and also speech therapy. Clinical question: Is there any correlation between brain abnormality/damage with unilateral hearing loss and delayed speech in Lennox-Gastaut syndrome? Method: Using Pubmed, Proquest Database, and Hand Searching to search the evidence. The evidence selected will be appraised by at least two members of our group using Oxford Center of Evidence-Based Medicine (CEBM) worksheet. Result: Following screening of double publication and its suitability to our clinical questions over ten years, no literature was found. Conclusion: The patient was given antiepileptic drugs (AEDs) and postural control training. For the hearing and speech problems, as the best comprehensive treatment the patient was suggested to use hearing aids and undergo speech therapy program. ABSTRAKLatar belakang: Lennox-Gastaut syndrome (LGS) adalah kumpulan gejala epilepsi berat pada anak dengan ciri khas kejang multipel, tonik, atonik, kejang absans atipik dan tonik klonik menyeluruh. LGS juga berkaitan dengan penurunan kognitif dan berbagai gangguan saraf, termasuk gangguan pendengaran. Tujuan: melaporkan kasus sindrom Lennox-Gastaut dengan gangguan pendengaran satu sisi dan keterlambatan bicara. Laporan Kasus: Seorang anak laki-laki berusia 4 tahun dengan sindroma Lennox-Gastaut mengalami keterlambatan bicara dirujuk ke Departemen Telinga Hidung Tenggorok, Rumah Sakit Dr.Cipto Mangunkusumo untuk evaluasi ambang dengar dan penanganannya. Riwayat penyakit menunjukkan kejang berulang sejak berusia tiga minggu, yang ditemukan juga lesi di korteks serebri dan atrofi ringan pada hemisfer otak kiri. Berdasarkan Otoacoustic Emission (OAE), Brainstem Evoked Response Audiometry (BERA), dan Auditory Steady State Response (ASSR) ditemukan adanya gangguan pendengaran sangat berat unilateral pada telinga kiri dan membutuhkan Alat Bantu Dengar dan terapi wicara. Pertanyaan klinis:Apakah terdapat korelasi antara abnormalitas otak atau kerusakan otak dengan gangguan pendengaran unilateral dan keterlambatan bicara pada LGS? Metode: Pencarian bukti dilakukan melalui PubMed, Proquest, dan pencarian manual. Artikel yang didapatkan kemudian ditelaah oleh setidaknya dua anggota kelompok dengan menggunakan lembar kerja yang diperoleh dari Oxford Center of Evidence-Based Medicine (CEBM) Hasil: Setelah dilakukan skrining publikasi ganda dan kesesuaian dengan pertanyaan klinis dari sepuluh tahun terakhir tidak ditemukan literatur yang sesuai. Kesimpulan:  Pasien ditangani dengan obat antiepilepsi dan latihan psikomotorik. Untuk gangguan pendengaran pasien dianjurkan untuk menggunakan Alat bantu Dengar dan terapi wicara. Penanganan kasus LGS harus menyeluruh untuk memperoleh hasil yang baik.
Effect of Exclusive Breastfeeding on Neurodevelopmental of Children 6-24 Months: A Case-Control Study Putri, Armitha; Mangunatmadja, Irawan; Tantri, Aida Rosita
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.3.4.2024.15-22

Abstract

Background: The ketogenic diet (KD) has long been prescribed to children with recurrent epilepsy due to its minimal neurotoxic effects. The side effects caused this diet to be abandoned. New diets are emerging as options such as modified Atkins diet (MAD), low glycemic index therapy (LGIT) and medium-chain triglyceride (MCT). This study compared the safety and effectiveness of the KD and these new methods. Method: Systematic review was conducted by searching databases such as PubMed, ScienceDirect, SpringerOpen, Cochrane, Proquest and Scopus based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Result: : A total of 439 pediatric patients aged 0 - 18 years who were intervened with a ketogenic diet compared with other dietary options. A total of five studies reported a higher mean reduction in seizure incidence >90% in children who were intervened with a ketogenic diet compared to other diets, one of which reported KD > MAD (53.3% KD vs. 26.6% MAD). Conclusion: Although KD remains effective, MAD, LGIT, MCT and Polyunsaturated Fatty Acids KD (PUFAKD) diets provide comparable benefits with potential for better adherence. The classic KD group showed a higher morbidity rate; however, it demonstrated significant effectiveness in lowering the incidence of recurrent seizures in children.
Secretome from hypoxic mesenchymal stem cells as a potential therapy for ischemic stroke: Investigations on VEGF and GFAP expression Silvana, Sisca; Japardi, Iskandar; Rusda, Muhammad; Daulay, Rini S.; Putra, Agung; Mangunatmadja, Irawan; Darlan, Dewi M.; Sofyani, Sri; Andreas, Yana
Narra J Vol. 4 No. 3 (2024): December 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i3.1181

Abstract

Ischemic stroke is a sudden onset of neurological deficit resulting from a blockage in cerebral blood vessels, which can lead to brain tissue damage, chronic disability, and increased risk of mortality. Secretome from hypoxic mesenchymal stem cells (SH-MSC) is a potential therapy to improve neurological deficit by increasing the expression of vascular endothelial growth factor (VEGF) and reducing glial fibrillary acidic protein (GFAP). These effects can reduce the infarction area of ischemic stroke. Therefore, the aim of this study was to analyze the effect of 150 μL and 300 μL SH-MSC injection on VEGF and GFAP expression as well as the improvement of infarction area in ischemic stroke animal model. A post-test-only experimental design with consecutive sampling was used, with Rattus norvegicus as subjects. Stromal mesenchymal stem cells (S-MSCs) were isolated from the umbilical cords of rats at 21 days of gestation. Secretome production by the S-MSCs was induced under a hypoxic condition, and subsequently isolated. The resultant secretome was administered to rats subjected to middle cerebral artery occlusion (MCAO) at doses of 150 μL (P1 group) and 300 μL (P2 group). The results showed that the infarction area was reduced in P1 (p<0.001) and P2 groups (p<0.001). SH-MSC at a dose of 300 μL increased the expression of VEGF (p=0.028) and reduced the expression of GFAP (p=0.001). In conclusion, secretome from hypoxic S-MSC could potentially improve ischemic stroke by upregulating VEGF expression and downregulating GFAP expression.
Risk factors of drug-resistant epilepsy in children under three-year-old Sukmono, Suryawati; Mangunatmadja, Irawan; Pardede, Sudung O.
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/pi65.1.2025.42-7

Abstract

Background Repeated seizures may result in chronic injury to the brain, triggering the neuroplasticity process that can cause or augment existing pathological processes. High neuroplasticity during first 3 year of life may influence the clinical course and outcome of children with epilepsy. Objective To evaluate initial risk factors and evolution risk factors during treatment to predict drug-resistant epilepsy in children under 3 years old. Initial risk factors consist of initial seizure frequency, seizure type, imaging result, history of febrile convulsion, neurodevelopmental status and initial electroencephalography (EEG) result. Evolution risk factors evaluate changes in initial risk factors and seizure control after treatment. Evolution risk factors consist of early response to therapy (seizure control during the first 6 months of treatment), evolution of seizure type and frequency, changes in EEG (background rhythm and epileptiform discharges) during treatment and neurodevelopmental evolution. Methods This retrospective cohort study used medical record data of pediatric patients 1 month to 3 years old with drug-resistant epilepsy seeking treatment at Cipto Mangunkusumo Hospital, Anakku Clinic Pondok Pinang, and National Brain Center Hospital, Jakarta, from 2015 to 2020. Results Thirty-three subjects met drug-resistant epilepsy criteria. Abnormal EEG was the only initial risk factor significantly associated with drug-resistant epilepsy (OR 4.48; 95%CI 1.82 to 11.03; P=0.001). Increased seizure frequency (aOR 7.0; 95%CI 1.0 to 49.7; P=0.048) and seizure persistence during the first six months of treatment (aOR 10.92; 95%CI 2.6 to 45.87; P=0.01) were significantly related with drug-resistant epilepsy. Conclusion Abnormal initial EEG result was the only initial risk factor associated with drug-resistant epilepsy. Evolution risk factors associated with drug-resistant epilepsy were increased seizure frequency and seizure persistence in the first six months of treatment.
Efek Penggunaan Deksametason Ajuvan untuk Meningitis Bakteri pada Anak Handryastuti, Setyo; Rafli, Achmad; Wicaksono, Yuda Satrio; Mangunatmadja, Irawan; Soebadi, Amanda; Santoso, Dara Ninggar
Sari Pediatri Vol 25, No 6 (2024)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp25.6.2024.405-13

Abstract

Latar belakang. Meningitis bakterial pada anak, umumnya disebabkan oleh Streptococcus pneumoniae, Neisseria meningitidis, dan Haemophilus influenzae tipe b. Penggunaan deksametason sebagai terapi ajuvan untuk antibiotik masih menjadi perdebatan pada kasus meningitis bakterialis anak karena adanya bukti yang kontradiktif mengenai dampaknya terhadap hasil luaran klinis.Tujuan. Meninjau literatur yang ada mengenai efek dari penggunaan deksametason pada meningitis bakteri pada anak, dengan fokus pada morbiditas, mortalitas, dan efek samping.Metode. Pencarian literatur sistematis dilakukan menggunakan database Pubmed, EMBASE, Scopus, dan Cochrane. Studi yang memenuhi kriteria inklusi adalah uji klinis acak atau meta-analisis, diterbitkan dalam bahasa Inggris, dilakukan dalam 10 tahun terakhir, dan membandingkan efek penggunaan deksametason pada meningitis bakterial anak.Hasil. Lima meta-analisis disertrakan dalam tinjauan ini. Tidak terdapat penurunan signifikan dalam mortalitas dengan penggunaan deksametason dibandingkan plasebo. Konsistensi temuan menunjukkan manfaat deksametason pada fungsi pendengaran pasien meningitis bakteri. Efek terhadap kelainan neurologis masih belum jelas, dan efek samping cenderung serupa antara kelompok yang diobati dan tidak.Kesimpulan. Bukti menunjukkan potensi manfaat deksametason pada fungsi pendengaran anak dengan meningitis bakteri. Namun, dampak terhadap mortalitas dan kelainan neurologis masih memerlukan penelitian lebih lanjut. Keputusan penggunaan deksametason harus dipertimbangkan dengan hati-hati oleh dokter, sementara penelitian lanjutan, terutama dosis optimal untuk hasil neurologis, diperlukan.
Co-Infection of Tuberculosis and COVID-19 in Children: A Case Report Jasin, Madeleine Ramdhani; Ayuningtyas, Talitha Rahma; Rafli, Achmad; Mangunatmadja, Irawan; Indawati, Wahyuni; Kaswandani, Nastiti
Jurnal Respirologi Indonesia Vol 44 No 1 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i1.323

Abstract

Background:Coinfection TB and COVID-19 might occur, yet few evidence has been reported. Current COVID-19 pandemic also results in disruption at TB management in the community. Case: A 5-month-old boy came with recurrent seizure, with history of persistent cough and fever for 1 month prior, also positive possible TB contact. The diagnosis was disseminated TB (miliary and meningitis), coinfected with COVID-19.Discussion: During COVID-19 pandemic, TB service in the community is disrupted resulting in delay in TB diagnosis, as observed in this patient, leading to severe manifestation. Coinfection of TB and COVID-19 can occur and may lead to more severe symptoms in either both diseases. Management of TB COVID-19 coinfected children is similar to those without COVID-19. Our patient received treatment consisting of 2 RHZE then 10 RH. Monitoring of symptoms and possible sequelae is necessary.Conclusion: Coinfection TB and COVID-19 may occur in children, and both can lead to more severe manifestation of each condition, particularly if diagnosis is delayed. Strengthening TB care in the community is essential so that there will be no delay in diagnosis, also no disruption in treatment and monitoring.Keywords COVID-19, tuberculosis, coinfection, children
Co-Authors A. C. Van Huffelen Abdul Latief Adrian Prasetya Sudjono Agatha Geraldyne Agung Putra Agung Triono Agus Firmansyah Agus Firmansyah Agus Firmansyah Alan Roland Tumbelaka Alifiani H. Putranti Aman Pulungan Amanda Seobadi Andreas, Yana Anna Tjandradjani Anton Dharma Saputra Antonius H. Pudjiadi Antonius Pudjiadi Aryono Hendarto Asep Aulia Rachman Ayuningtyas, Talitha Rahma Bambang Tridjadja, Bambang Bambang Tridjaja AAP, Bambang Tridjaja Budiati Laksmitasari Citra Raditha Conny Tanjung Cut Nurul Hafifah Daisy Widiastuti Danu, Nugroho Darlan, Dewi M. Darmawan B. Setyanto Daulay, Rini S. Deasy Grafianti Dedy Rahmat Dheeva Noorshintaningsih Dina Indah Mulyani, Dina Indah Dini Prima Utami Dwi P. Widodo Dwi Putro Widodo Dwi Putro Widodo Dwi Putro Widodo E S Herini Elisabeth Siti Herini Endang Windiastuti Eva Devita Harmoniati Evita Bermansyah Ifran Fathy Pohan Fatmawaty Fatmawaty Fijri Auliyanti H F Wulandari Hardiono D Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro, Hardiono D. Hartono Gunardi Hartono Gunardi Haryanti Fauziah Wulandari Herlina Herlina Hidra Irawan Satari Hikari Ambara Sjakti, Hikari Ambara I. Budiman Idham Amir, Imral Chair Inez Ayuwibowo Sangwidjojo Iqbal Taufiqqurrachman Irene Yuniar, Irene Irma Rochima Puspita Iskandar Japardi Isman Jafar Ismy, Jufitriani Jasin, Madeleine Ramdhani Joanna Erin Hanrahan KHOIRUL ANAM Kristian Kurniawan Lenny S. Budi Lily Rundjan Luh Karunia Wahyuni, Luh Karunia Mardjanis Said Mardjanis Said Marissa Tania Stephanie Pudjiadi Masayu Rita Dewi Melinda Harini Merci Monica br Pasaribu Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Murti Andriastuti, Murti Muzal Kadim Nahari Arifin Najib Advani Nastiti Kaswandani Nia Kurniati Nur Hayati Pamungkas, Indra Parmaditya Partini Pudjiastuti Trihono Purboyo Solek Pustika Amalia Pustika Amalia Putri, Armitha Putri, Shally Adhina Adhina R. H. J. M Gooskens Rachmawati, Elvie Zulka Kautzia Rafli, Achmad Rina W Sundariningrum Rinawati Rohsiswatmo Rini Sekartini Risma Kerina Kaban Rismala Dewi Rizal Agus Tiansyah Ronny Suwento, Ronny Rosalina Roeslani Rosary Rosary Rulina Suradi Rulina Suradi Rulina Suradi Rusda, Muhammad Safarina G. Malik Santoso, Dara Ninggar Sari, Teny T. Setyanto, Darmawan Budi Setyo Handryastuti Setyo Handryastuti Setyo Handryastuti Setyo Handryastuti, Setyo Sisca Silvana, Sisca Soebadi, Amanda Soedjatmiko Soepardi Soedibyo Sri Rezeki Hadinegoro Sri Sofyani, Sri Sudigdo Sastroasmoro Sudjatmiko Sudjatmiko Sudung O Pardede, Sudung O Sudung O. Pardede Sudung O. Pardede, Sudung O. Sukman Tulus Putra Sukmono, Suryawati Susanti Himawan Tantri, Aida Rosita Taralan Tambunan Taralan Tambunan Taralan Tambunan Taralan Tambunan Tatang M. Puspandjono Teny Tjitra Sari Titis Prawitasari, Titis Tri Lestari Handayani Tuty Victor Prasetyo Poernomo Vimaladewi Lukito Wahyuni Indawati, Wahyuni Wicaksono, Yuda Satrio Winny N Wishwadewa Wulandari, Harjanti F Wulandari, Harjanti F Yazid Dimyati Yeti Ramli Yeti Ramli Yuliarti, Klara Zizlavsky, Semiramis