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Multipel Sklerosis pada Anak Fredyton Rizminardo; Iskandar Syarief; Rahmi Lestari; Tuti Handayani
Jurnal Kesehatan Andalas Vol 7 (2018): Supplement 4
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v7i0.927

Multipel sklerosis (MS) adalah suatu penyakit neurodegeneratif akibat proses demielinisasi kronik pada sistem saraf pusat yang disebabkan oleh peradangan autoimun. Penyakit ini umumnya mengenai kelompok pasien usia dewasa muda (antara 30 sampai 40 tahun) dengan prevalensi umum di seluruh dunia adalah 30 kasus per 100.000 populasi; dan hanya sekitar 2-5% penyakit ini terjadi pada usia kurang dari 18 tahun. Berbeda halnya dengan yang terjadi pada populasi dewasa, penyakit MS pada populasi anak memiliki sejumlah variasi manifestasi klinis demielinisasi atipikal yang menyebabkan pengenalan dan diagnosis MS pada pasien anak merupakan suatu proses yang rumit. Telah dilaporkan suatu laporan kasus pada seorang anak perempuan berusia 13 tahun 7 bulan dengan keluhan utama kejang yang disertai penurunan kesadaran, dimana kedua manifestasi klinis ini merupakan manifestasi klinis yang jarang ditemukan pada pasien multiple sklerosis. Diagnosis MS pada pasien ditegakkan setelah dilakukannya pemeriksaan MRI kepala. Pasien kemudian diterapi dengan menggunakan steroid intravena dan pada pengamatan selanjutnya ditemukan perbaikan klinis yang nyata.

Faktor Risiko Terjadinya Epilepsi pada Anak Palsi Serebral M Luthfi Suhaimi; Iskandar Syarif; Eva Chundrayetti; Rahmi Lestari
Jurnal Kesehatan Andalas Vol 9, No 2 (2020): Online June 2020
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v9i2.1282

Pada anak yang menderita palsi serebral kemungkinan akan mengalami peningkatan risiko terjadinya epilepsy. Setiap perubahan pada otak dapat menjadi faktor risiko terjadinya epilepsi dengan berbagai manifestasi klinis. Tujuan: Mengetahui hubungan antara faktor risiko dengan terjadinya epilepsi pada anak palsi serebral di RSUP Dr. M. Djamil Padang. Metode: Desain peneltian ini adalah cross-sectional study yang dilaksanakan pada Agustus 2018 sampai Desember 2019. Subjek palsi serebral diperoleh secara consecutive sampling, dengan jumlah minimal 60 subjek. Faktor risiko yang diteliti meliputi asfiksia, persalinan vakum ekstraksi, berat badan lahir rendah, prematuritas dan kejang neonatal. Uji statistik menggunakan Chi-square test dan Fisher’s exact test, dengan batas kemaknaan p<0,05. Hasil: Pada 60 pasien palsi serebral, ditemukan 39 pasien (65%) menderita epilepsi dan 21 pasien (35%) tidak menderita epilepsi. Perbandingan jenis kelamin perempuan dan laki-laki 1,2:1. Epilepsi umum merupakan tipe epilepsi yang paling banyak ditemukan (76,9%), pengobatan secara politerapi hampir sama banyak dengan monoterapi. Asfiksia, persalinan vakum ekstraksi, berat badan lahir rendah, prematuritas dan kejang neonatal tidak bermakna sebagai faktor risiko epilepsi pada anak palsi serebral. Simpulan: Tidak terdapat hubungan antara asfiksia, persalinan vakum ekstraksi, berat badan lahir rendah, prematuritas dan kejang neonatal dengan terjadinya epilepsi pada anak palsi serebral.Kata kunci: cerebral palsy, epilepsy, risk factors

Intraventricular Hemorrhage in Children with COVID-19 Confirmed Utari Gustiany G; Rahmi Lestari; Finny Fitry Yani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 6 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i6.526

Background. The most common symptom of Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is respiratory symptoms. However, neurological symptoms in adult patients are increasingly being reported. In children, neurological symptoms of COVID-19 are still underreported. This case report was aimed to describe intraventricular hemorrhage in a child with Covid-19 infection. Case presentation. We report a case of a 15-year-old girl with intraventricular bleeding, which is one of the COVID-19 infection symptoms or a possible symptom of a multisystem inflammatory syndrome in children (MIS-C). Laboratory tests on the first day of treatment showed an increase in leukocytes and decreased lymphocytes. On the 6th day of treatment, the patient had worsening symptoms of consciousness and high fever. The results of laboratory examination showed a decrease in kidney function and an increase in D-dimer. Conclusion. Severe clinical manifestations of COVID-19 can be in the form of neurological manifestations, one of which is intraventricular hemorrhage.

Identifikasi virus herpes simpleks pada anak dengan ensefalitis: sebuah studi pendahuluan Rahmi Lestari; Andani Eka Putra
Majalah Kedokteran Andalas Vol 40, No 2 (2017): Published in September 2017
Publisher : Faculty of Medicine, Universitas Andalas

Ensefalitis Herpes simpleks merupakan salah satu penyebab infeksi virus yang paling berat pada otak manusia. Tanpa terapi yang adekuat mortalitas mencapai 70% dan sebagian besar dari pasien yang bertahan hidup akan menderita sekuele neurologis berat. Data tentang prevalensi dan proporsi Herpes simpleks ensefalitis pada anak di Indonesia belum tersedia. Tujuan: Untuk menentukan proporsi ensefalitis Herpes simpleks pada anak dengan ensefalitis di RSUP M. Djamil Padang. Metode: Penelitian dilaksanakan di Instalasi Rawat Inap Anak RSUP M. DJamil Padang dari bulan Agustus hingga Desember 2016. Ensefalitis didefinisikan menurut konsensus International Encephalitis Consortium. Variabel yang dicatat meliputi usia, jenis kelamin, manifestasi klinis, dan luaran. Subjek dikatakan menderita ensefalitis Herpes simpleks bila hasil pemeriksaan polymerase chain reaction Herpes simpleks pada cairan serebro spinal memberikan hasil positif. Sebanyak empat belas orang anak memenuhi kriteria inklusi selama periode penelitian. Hasil: Manifestasi klinis yang paling sering ditemukan adalah demam, kejang, dan penurunan kesadaran. Sebagian besar subjek pulang dengan sekuele. Tidak ada virus Herpes simpleks yang ditemukan pada pemeriksaan PCR terhadap cairan serebrospinal. Kesimpulan: Tidak ada ensefalitis Herpes simpleks yang teridentifikasi pada penelitian ini. Dibutuhkan studi lebih lanjut dengan subjek yang lebih besar dan periode penelitian yang lebih panjang untuk mendapatkan gambaran besarnya masalah ensefalitis Herpes simpleks pada anak di Indonesia.

Enzyme-Inducing Antiseizure Medications and Hypovitaminosis D in Children with Epilepsy: A Cross-Sectional Study in West Sumatera, Indonesia Trisna Yunita; Rahmi Lestari; Nice Rachmawati Masnadi; Eva Chundrayetti; Amirah Zatil Izzah; Indra Ihsan; Rinang Mariko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1642

Background. Long-term antiseizure-medication (ASM) therapy can accelerate vitamin D catabolism via hepatic cytochrome P450 induction, predisposing children with epilepsy to hypovitaminosis D and its skeletal consequences; Indonesian tertiary-centre data remain scarce. Methods. This cross-sectional study examined the association between ASM class, number and duration and serum 25-hydroxyvitamin D [25(OH)D] in children aged 1–18 years at Dr. M. Djamil General Hospital, Padang, West Sumatera, between April and October 2025. Of 82 records screened, 77 were eligible; 25(OH)D was measured by enzyme-linked fluorescent assay, with hypovitaminosis D defined as <30 ng/mL. Associations were tested with Fisher–Freeman–Halton exact and chi-square tests, odds ratios, ANOVA, multivariable logistic regression and ROC analysis. Results. Hypovitaminosis D affected 48 children (62.3%; 95% CI 51.2–72.3), with mean 25(OH)D of 18.3±6.7 versus 41.6±11.2 ng/mL in deficient versus replete children. ASM class was significantly associated with vitamin D status (exact p=0.037; Cramér's V=0.283): all nine enzyme-inducing users were deficient, versus 56.0% non-enzyme-inducing and 58.1% combination (ANOVA p=0.045, η²=0.080). Neither ASM number (p=0.642) nor duration (p=0.348) was associated. Enzyme-inducing exposure carried the largest adjusted odds (adjusted OR 5.66, 95% CI 0.62–52.06), and the model discriminated moderately (AUC 0.685). Conclusion. Hypovitaminosis D is prevalent in Indonesian children with epilepsy and is most strongly linked to enzyme-inducing ASMs, supporting early routine 25(OH)D monitoring and supplementation from treatment initiation.

Histamine-2 Receptor Antagonist for Gastric Bleeding Prophylaxis in Low-Risk Critically Ill Children: A Randomized Trial of Ranitidine Sylvetri Lestari; Mayetti; Yusri Dianne Jurnalis; Eva Chundrayetti; Rusdi; Rahmi Lestari; Rinang Mariko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i10.1397

Background: The utility of stress ulcer prophylaxis (SUP) in critically ill children is a subject of ongoing debate, particularly in patients who do not present with classic high-risk features for stress-related mucosal disease (SRMD). This study aimed to evaluate the efficacy of ranitidine for preventing gastric bleeding in a heterogeneous cohort of critically ill children. Methods: A single-center, prospective, open-label, randomized controlled trial was conducted in a tertiary Pediatric Intensive Care Unit (PICU) in Indonesia. Children aged 1 month to 18 years admitted to the PICU were randomized to receive either intravenous ranitidine (1 mg/kg/dose twice daily) or standard care without prophylaxis for five days. The primary outcome was the incidence of overt gastric bleeding. Post-hoc power analysis and multivariable logistic regression were performed to contextualize the findings. Results: From 243 patients screened, 60 were randomized (30 per group). The cohort was predominantly composed of infants (60.0%) with respiratory distress. Overt gastric bleeding occurred in 1 of 30 patients (3.3%) in the ranitidine group versus 3 of 30 patients (10.0%) in the control group. This difference was not statistically significant (Relative Risk [RR] 0.33; 95% CI 0.04–3.11; p=0.612). After adjusting for a baseline imbalance in age, the odds of bleeding remained non-significantly lower in the ranitidine group (Adjusted Odds Ratio [aOR] 0.29; 95% CI 0.03–3.20). The study was found to be severely underpowered (16% power), and none of the bleeding events were clinically significant. Conclusion: In this small, underpowered trial of predominantly low-risk critically ill children, ranitidine did not significantly reduce the incidence of overt gastric bleeding. These findings, while limited by significant methodological weaknesses, do not support the routine use of SUP in similar pediatric populations and underscore the critical need for larger, more definitive trials to inform evidence-based risk-stratification strategies.

Enzyme-Inducing Antiseizure Medications and Hypovitaminosis D in Children with Epilepsy: A Cross-Sectional Study in West Sumatera, Indonesia Trisna Yunita; Rahmi Lestari; Nice Rachmawati Masnadi; Eva Chundrayetti; Amirah Zatil Izzah; Indra Ihsan; Rinang Mariko
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 8 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i8.1642

Background. Long-term antiseizure-medication (ASM) therapy can accelerate vitamin D catabolism via hepatic cytochrome P450 induction, predisposing children with epilepsy to hypovitaminosis D and its skeletal consequences; Indonesian tertiary-centre data remain scarce. Methods. This cross-sectional study examined the association between ASM class, number and duration and serum 25-hydroxyvitamin D [25(OH)D] in children aged 1–18 years at Dr. M. Djamil General Hospital, Padang, West Sumatera, between April and October 2025. Of 82 records screened, 77 were eligible; 25(OH)D was measured by enzyme-linked fluorescent assay, with hypovitaminosis D defined as <30 ng/mL. Associations were tested with Fisher–Freeman–Halton exact and chi-square tests, odds ratios, ANOVA, multivariable logistic regression and ROC analysis. Results. Hypovitaminosis D affected 48 children (62.3%; 95% CI 51.2–72.3), with mean 25(OH)D of 18.3±6.7 versus 41.6±11.2 ng/mL in deficient versus replete children. ASM class was significantly associated with vitamin D status (exact p=0.037; Cramér's V=0.283): all nine enzyme-inducing users were deficient, versus 56.0% non-enzyme-inducing and 58.1% combination (ANOVA p=0.045, η²=0.080). Neither ASM number (p=0.642) nor duration (p=0.348) was associated. Enzyme-inducing exposure carried the largest adjusted odds (adjusted OR 5.66, 95% CI 0.62–52.06), and the model discriminated moderately (AUC 0.685). Conclusion. Hypovitaminosis D is prevalent in Indonesian children with epilepsy and is most strongly linked to enzyme-inducing ASMs, supporting early routine 25(OH)D monitoring and supplementation from treatment initiation.

KARAKTERISTIK KATARAK PADA DIABETES MELITUS DI RSUP DR. M DJAMIL PERIODE 2020-2021 Nada Shafa Salsabila; Kemala Sayuti; Rahmi Lestari; Rudy Afriant; Hendriati Hendriati; Yustini Alioes
SINERGI : Jurnal Riset Ilmiah Vol. 3 No. 2 (2026): SINERGI : Jurnal Riset Ilmiah, February 2026
Publisher : Lembaga Pendidikan dan Penelitian Manggala Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.62335/sinergi.v3i2.2357

Cataracts are a condition in which the normally clear and clear lens of the eye turns cloudy. Cataracts that occur due to disorders of the endocrine system are caused by diabetes mellitus. This study aims to determine the characteristics of cataracts in diabetes mellitus at RSUP Dr. M Djamil Padang Period 2020 –2021. This research was a retrospective descriptive study with a cross-sectional approach to determine the characteristics of cataracts in patients with diabetes mellitus at RSUP Dr. M Djamil for the period 2020 - 2021. This study used secondary data in the form of medical records from 39 cataract patients with a history of diabetes mellitus. Data analysis was carried out in the form of descriptive analysis using the SPSS application. This study showed that 28 people (71.8%) respondents aged ≥ 60 years, 24 people were male (61.5%), 30 patients with duration of diabetes mellitus ≥5 years (76.9%), 19 respondents (48.7%) had mature cataracts. Individuals aged ≥ 60 years mostly had mature cataracts (14 people; 50.0%), male respondents mostly had mature cataracts (12 people; 50.0%) and individuals with cataract duration ≥ 5 years mostly had mature cataracts (17 people; 56.7%). The conclusion of this study is the discovery of cataracts in diabetes mellitus with the most age ≥ 60 years, male gender, duration of diabetes mellitus ≥5 years, and type of mature cataract. Most mature cataracts were found at age ≥ 60 years, male gender, and duration of diabetes mellitus ≥5 years.

From Decision to Delivery: A Twelve- to Fourteen-Day Interval Before Plasma Exchange in a Child with Ventilator-Dependent Axonal Guillain-Barré Syndrome Doni Trinanda; Rahmi Lestari
Scientific Journal of Pediatrics Vol. 4 No. 1 (2026): Scientific Journal of Pediatrics
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjped.v4i1.339

Background: Guillain–Barré syndrome is the commonest cause of acute flaccid paralysis in children. Plasma exchange is accepted when immunoglobulin fails, but the interval from a treatment decision to its delivery is rarely reported. Objective: To measure the interval between the written decision to escalate to plasma exchange and the first session, and to re-score instruments left uncomputed during admission. Methods: This CARE-guided case report audited the de-identified clinical record, preserved stated discordances, and recomputed clinical scores, treatment doses, nutritional estimates, and dated intervals. Results: An 8-year-old boy presented after limb weakness following a diarrhoeal illness, with motor strength graded 1 in all four limbs. Immunoglobulin 0.4 g/kg/day was given for 5 days. Respiratory failure occurred on hospital day 4 and mechanical ventilation continued for 21 days. Plasma exchange was planned on day 10; the first session was completed between days 22 and 24, giving a decision-to-delivery interval of 12–14 days. Three exchanges were completed and a fourth was cancelled. Re-scoring yielded an Erasmus respiratory insufficiency score of 5 or 6 of 7 and Brighton level 2 rather than 1. Weight fell from 77.8% to 70.4% of the documented ideal weight. Conclusion: At the last review, the disability score was unchanged from admission. Motor recovery was documented before the earliest possible first exchange, so no treatment effect can be claimed. A 10-item minimum data set is proposed.

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