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All Journal Jurnal Kedokteran Syiah Kuala The Indonesian Biomedical Journal Sari Pediatri Paediatrica Indonesiana Indonesian Journal of Cancer Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management)

Teny Tjitra Sari, Teny Tjitra

Departemen Ilmu Kesehatan Anak FKUI/RSCM, Jakarta

Author-ID : 601754

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

Published : 19 Documents Claim Missing Document

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Seng dan Respons Imun pada Talasemia Teny Tjitra Sari
Sari Pediatri Vol 18, No 2 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp18.2.2016.157-63

Infeksi merupakan morbiditas dan mortalitas yang penting pada pasien talasemia. Mekanisme terjadinya infeksi yang berperan adalahÂ gangguan respons imun akibat patofisiologi penyakit talasemia, kelebihan besi, splenektomi dan defisiensi seng. Seng merupakanÂ zat penting pada respons imun yang dihubungkan dengan akivitas timulin. Kadar feritin yang tinggi juga memengaruhi kadar sengÂ pada pasien talasemia. Suplementasi seng memperbaiki kadar seng yang berakibat pada perbaikan stres oksidatif dan respons imunpada pasien talasemia.Â Â

Indeks Mentzer sebagai Alat Diagnostik Anemia Defisiensi Besi di Sarana Kesehatan dengan Fasilitas Terbatas: Perbandingan Berbagai Nilai Cut Off Teny Tjitra Sari; Nur Aliza; Soedjatmiko Soedjatmiko
Sari Pediatri Vol 21, No 3 (2019)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Latar belakang. Anemia defisiensi besi (ADB) adalah penyebab tersering anemia pada anak kurang dari 5 tahun dan dapat menyebabkan gangguan kognitif, perilaku, dan pertumbuhan yang menetap sehingga diagnosis harus ditegakkan sedini mungkin. Diagnosis ADB ditegakkan dengan pemeriksaan laboratorium yang mahal dan tidak tersedia merata di Indonesia. Untuk itu, penggunaan Indeks Mentzer (IM) merupakan salah satu alat penegakan diagnosis yang mudah. Tujuan. Mengetahui validitas IM untuk mendiagnosis ADB di daerah dengan fasilitas terbatas, dan mengetahui apakah cut-off point baru diperlukan untuk populasi di Indonesia. Metode. Penelitian ini merupakan uji diagnostik dengan metode potong lintang. Subjek adalah anak sehat berusia 12-59 bulan yang pucat. Penapisan dilakukan di 27 Posyandu dan 27 PAUD di Kecamatan Jatinegara. Subjek yang memenuhi kriteria inklusi menjalani pemeriksaan darah perifer lengkap, kemudian subjek dengan anemia mikrositik hipokrom diperiksa profil besi dan C-reactive protein (CRP). Validitas dinilai dengan membandingkan IM dengan hasil profil besi. Penentuan cut-off point spesifik untuk populasi di Indonesia dilakukan dengan membandingkan sensitivitas, spesifisitas, nilai duga positif (NDP) dan negatif (NDN), rasio kemungkinan positif (RKP), dan rasio kemungkinan negatif (RKN) antara beberapa cut-off points.Hasil. Penelitian ini mendapatkan 340 subjek dengan klinis pucat, 100 subjek setuju untuk melakukan pemeriksaan laboratorium, dan sisa 45 subjek dengan anemia mikrositik hipokrom. Penelitian ini memberikan sensitivitas 60,5%, spesifisitas 28,6%, NDP 82,1%, NDN 11,8%, RKP 0,9, dan RKP 1,4. Titik potong baru yang disarankan adalah 10,7 dengan sensitivitas 81,6% dan NDP 86,1%.Kesimpulan. Nilai diagnostik IM rendah dengan NDP yang baik untuk diagnosis ADB. Titik potong 10,7 dapat juga digunakan sebagai uji tapis ADB di fasilitas terbatas.

Gross motor dysfunction as a risk factor for aspiration pneumonia in children with cerebral palsy Cut Nurul Hafifah; Darmawan Budi Setyanto; Sukman Tulus Putra; Irawan Mangunatmadja; Teny Tjitra Sari; Haryanti Fauziah Wulandari
Paediatrica Indonesiana Vol 57 No 5 (2017): September 2017
Publisher : Indonesian Pediatric Society

Background Respiratory problems, such as aspiration pneumonia, are major causes of morbidity and mortality in children with cerebral palsy (CP) and greatly affect the quality of life of these children. Nevertheless, there is limited data on the incidence and risk factors of aspiration pneumonia in children with CP in Indonesia. Objective To determine the incidence and risk factors of aspiration pneumonia in children with cerebral palsy.Methods In children with CP aged 1-18 years, incidence of pneumonia was studied prospectively for 6 months and the prevalence of the risk factors was studied cross-sectionally. At baseline, we evaluated subjectsâ€™ by history-taking, physical examination, risk factors, and chest X-ray to assess the incidence of silent aspiration. Subjects were followed-up for six months to determine the incidence of overt or silent aspiration pneumonia.Results Eight out of 36 subjects had one or more episodes of aspiration, consisting of silent aspiration (2/36) and clinically diagnosed aspiration pneumonia (7/36). Subjects with more severe gross motor dysfunction experienced more episodes aspiration pneumonia, although it was not statistically significant (p = 0.06), while dysphagia (P=0.2) and nutritional status (P=0.11) were not associated with pneumonia or silent aspiration.Conclusion Twenty-five percent of children with CP experienced aspiration pneumonia during the 6-month study period, with gross motor dysfunction as a possible risk factor.

MANAJEMEN LEAN PADA LAYANAN KEMOTERAPI ANAK RAWAT INAP DI RUMAH SAKIT CIPTO MANGUNKUSUMO Teny Tjitra Sari; Andreasta Meliala; Firman
Journal of Health Service Management Vol 22 No 1 (2019)
Publisher : Departemen Kebijakan dan Manajemen Kesehatan, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta Jl. Farmako Sekip Utara Yogyakarta 55281 Telp 0274-547490

Background: Cancer in children has high morbidity and mortality. Retinoblastoma is the most common solid tumor in children at the Cipta Mangunkusumo Hospital (RSCM). Chemotherapy is one of the therapeutic modalities, interdisciplinary and many procedures. Lean management continuously reduces waste and improves work flow. Objective: This study used lean management to determine the efficiency of health care in teaching hospital. Methods: Action research was conducted at RSCM. Sampling by purposive sampling that represents the role in the flow of the service process. The observation guide uses cycle time observation sheets, value-added analysis sheets, waiting time and lead time. The waste found is listed in the DOWNTIME matrix. Observations were made on inpatient chemotherapy services for children and then a diagnosis was made using Value Stream Mapping. The Kaizen team consisted of pharmacists, nurses, doctors doing a plan-do-study-action, prepared an intervention plan, and conducted post-intervention observations. The 5S method is used to improve service flow. Results: In this study, patients with retinoblastoma in class III in patient ward included were 7 patients in the pre-intervention group and 16 patients in the postintervention group. Major decreases in lead time happened in the subprocesses of ordering chemotherapy (75%), decision-making of chemotherapy administration (55%) and filling of the resume (41%). Lead time process in chemotherapy administration for retinoblastoma changed from 48 hours, 36 minutes (more than 2 days) to 38 hours, 38 minutes (1.6 days or less than 2 days). The efficiency of the process was measured using value added ratio which showed changes from 33% to 37%. Conclusion: Lean management applied in the process of chemotherapy administration in the inpatient wards increased the efficiency of the process.

Zinc supplementation on cellular immune response in splenectomized thalassemia major Sari, Teny Tjitra; Gatot, Djajadiman; Akib, Arwin AP; Waspadji, Sarwono; Hadinegoro, Sri Rezeki S; Harahap, Alida Roswita; Idjradinata, Ponpon S
Paediatrica Indonesiana Vol. 64 No. 2 (2024): March 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.2.2024.145-51

Background: The immune response of thalassemia patients is different from usual; therefore, thalassemia patients are susceptible to infection. A study at Thalassemia Center in Cipto Mangunkusumo Hospital showed that all thalassemia patients experience zinc deficiency. The decreased cellular immune response is associated with zinc deficiency, whereas splenectomy exacerbates the condition. This study aims to evaluate the improvement of cellular immune response in splenectomized thalassemia major patients after zinc supplementation. Method: Randomized double-blinded controlled trial was conducted on splenectomized thalassemia major patients in 12 weeks period. The inclusion criteria were aged > 12 years and had negative HIV test results. The subject receiving corticosteroids were excluded. Fifty-six subjects were randomly divided into two groups, the zinc group and the placebo group. Between 2 groups, data on zinc serum, T lymphocyte count, CD4+ T lymphocyte count, CD8+ T lymphocyte count, and CD4+/CD8+ ratio were evaluated at the beginning and the end of the study and were analyzed with unpaired t-test, Mann Whitney test, and Wilcoxon Signed Rank test. Result: After zinc supplementation, only 18 of 28 subjects in the zinc group recovered normal zinc serum levels. There were no significant changes after zinc supplementation in all parameters of cellular immune response (p > 0.05) between the two groups. This might be due to the subjects' adherence, which was lower in the zinc group (75.82%) than in the placebo group (83.19%). Conclusion: The effect of zinc supplementation on cellular immune response in splenectomized thalassemia major patients had not been proven yet.

Functional gastrointestinal disorders in adolescents during online learning Simanjuntak, Sumardi F.; Prawitasari, Titis; Kadim, Muzal; Sari, Teny Tjitra; Gunardi, Hartono; Vandenplas, Yvan; Hegar, Badriul
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/pi63.5.2023.353-60

Background The COVID-19 pandemic necessitated the use of online schooling in order to comply with national and local lockdown guidelines. Online learning required students and teachers to adapt to a new method of schooling. The inability of adolescents to adapt to their environment can interfere with their psychosocial condition and become a risk factor for functional gastrointestinal disorders (FGID). Objective To determine the prevalence of FGID in adolescents and evaluate possible risk factors that existed during online learning. Methods This cross-sectional study was done in children aged 12-18 years who participated in online learning during the COVID-19 pandemic. The diagnosis of FGID was based on Rome IV criteria. Psychosocial problems were assessed using the Pediatric Symptom Checklist Questionnaire–17 (PSC-17) which includes internalization, externalization, and attention subscales. Subjects with a PSC-17 mixed subscale total score of >15 were considered as having an increased likelihood of having a behavioral health disorder. Data were collected by online questionnaires via Google Forms. Results Of 1,413 participants, 23% experienced FGID; of these, 32.6% had >2 FGID diagnostic criteria. Upon multivariate analysis, internalization psychosocial problems were the most common risk factors for FGID, followed by mixed subscale psychosocial problems, unstable internet connection, and not understanding of the material. ConclusionThe prevalence of FGID in adolescents in this study is 23%. Environmental and psychosocial conditions are interrelated as risk factors for FGID in adolescents during online learning in the COVID-19 pandemic.

Unveiling the Survival Gap: Addressing the Challenges of Acute Lymphoblastic Leukemia in Adolescents Aisyi, Mururul; Kosasih, Agus Susanto; Utomo, Ahmad Rusdan Handoyo; Saputra, Fahreza; Sari, Teny Tjitra; Sjakti, Hikari Ambara; Dwijayanti, Fifi; Harimurti, Kuntjoro; Andriastuti, Murti
Indonesian Journal of Cancer Vol 19, No 2 (2025): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v19i2.1396

Background: Acute Lymphoblastic Leukemia (ALL) remains the most common pediatric cancer, yet survival outcomes vary widely across age groups. In Indonesia, comprehensive data on ALL survival rates are sparse, particularly for adolescents who often fare worse than younger children. The underlying factors contributing to the difference in adolescent survival rates still need to be fully understood. This study aimed to evaluate and compare the survival rates of children and adolescents with ALL treated at Dharmais Cancer Hospital.Method: We conducted a retrospective cohort analysis of 94 ALL patients, including 37 adolescent patients and 71 patients with B-lineage ALL. All patients with ALL from 2021 to 2023 were identified. Children aged 1–18 years, diagnosed with ALL based on bone marrow results and not yet treated, are included in the study. Patients were stratified by risk stratification (Standard Risk [SR] vs. High Risk [HR]), lineage (B-lineage vs. T-lineage), and age group (children under 10 vs. adolescents 10 years and above). The survival curve was analyzed using the KaplanMeier method, and the log-rank test was used to assess and compare survival across groups.Results: The overall survival (OS) rate for ALL patients was 49.5%. Adolescents had a significantly lower OS rate of 23.2% compared to children. SR patients exhibited an OS rate of 95.7%, while HR patients had a 33.3%. B-cell lineage had a higher OS rate (59.8%) than T-cell lineage (15.9%). In B-cell ALL, OS was 61.4% in children but only 28.1% in adolescents. Conclusion: The survival rate for adolescents with acute lymphoblastic leukemia (ALL) is significantly lower than that of children, influenced by risk stratification, lineage, and age. Further research is needed to identify these risk factors through genetic and molecular analyses.Conclusion: The survival rate for adolescents with acute lymphoblastic leukemia (ALL) is significantly lower than that of children, influenced by risk stratification, cell type, and age. Unexplained factors, including lineage differences, remain a challenge in adolescents. Further research into genetic and molecular factors is essential to enhance treatment precision and improve survival rates for ALL patients in Indonesia, especially adolescents.Keywords: Overall Survival, Leukemia, Adolescent ALL, Stratification

Associations between genomic copy number alterations and clinical and laboratory results in pediatric B-cell acute lymphoblastic leukemia Aisyi, Mururul; Andriastuti, Murti; Kosasih, Agus Susanto; Utomo, Ahmad Rusdan Handoyo; Saputra, Fahreza; Sari, Teny Tjitra; Sjakti, Hikari Ambara; Dwijayanti, Fifi; Harimurti, Kuntjoro
Paediatrica Indonesiana Vol. 65 No. 2 (2025): March 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.2.2025.89-95

Background Copy Number Alterations (CNAs) are changes in DNA structure that lead to gain or loss of copies of DNA sections in the genome. They correlate with unfavorable prognostic outcomes in pediatric leukemia, influencing treatment resistance, relapse rates, and overall survival. Identifying high-risk patients with a likelihood of CNA positivity is essential for understanding its association with clinical characteristics and laboratory findings. Since routine CNA testing is costly, recognizing simple clinical and laboratory markers that predict CNA presence can help focus screening efforts, enabling more efficient risk stratification and prognosis assessment in acute leukemia Objective To describe the characteristics and analyze for associations between CNA, clinical characteristics, and laboratory findings in pediatric ALL patients. Methods This cross-sectional observational study included B-cell acute lymphoblastic leukemia (ALL) patients from three hospitals, excluding those above 18 years. Data collected encompassed demographics, clinical features, and laboratory results. We performed multiplex ligation-dependent probe amplification (MLPA) testing to identify CNA positivity. Results From January to December 2019, there were 74 pediatric ALL patients incuded in our study; 26 of them had positive results and the remaining 48 had negative results. CNA-positive status was commonly found in subjects aged ? 5 years (38.6%), while CNA-negative status was highest in patients aged ? 10 years (72.7%). CNA-positive status was significantly higher in patients with lymphadenopathy, lower hemoglobin level (7.73 g/dL), and lower platelet level (52,019/µL) (P<0.05). Conclusion Patients with lymphadenopathy, lower hemoglobin, and lower platelet levels are more likely to test positive for CNA. However, more research is needed to fully understand the implications of this finding and its potential impact on patient care.

Efektivitas Eltrombopag dalam Penanganan Anemia Aplastik Berat pada Anak Septiana, Mega; Sari, Teny Tjitra
Sari Pediatri Vol 27, No 2 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp27.2.2025.126-35

Latar belakang. Efektivitas pemberian eltrombopag pada kasus anemia aplastik berat pada anak masih kontroversial. Tujuan. Melakukan telaah kritis untuk melihat efektivitas pemberian eltrombopag dalam penanganan anemia aplastik berat pada anak.Metode. Penelusuran pustaka pangkalan data elektronik berupa PubMed, The Cochrane Library, dan Embase pada bulan Juli 2023. Pencarian dilakukan dengan menggunakan Boolean term dengan kata kunci berupa “severe anemia aplastic,” “children,” “pediatric,” dan “eltrombopag.”Hasil. Terdapat dua artikel yang dipilih kemudian dilakukan telaah kritis. Level of evidence kedua studi tersebut adalah 1a. Kedua studi tersebut menunjukkan pemberian eltrombopag memberikan perbaikan profil hematologi pada anak dengan anemia aplastik bila dikombinasikan dengan terapi imunosupresi standar. Meskipun demikian, tidak semua studi terlibat memiliki hasil yang sama.Kesimpulan. Pemberian eltrombopag pada anak dengan anemia aplastik berat menunjukkan kemungkinan perbaikan profil hematologi yang lebih besar dibandingkan tidak diberikan eltrombopag, pada pemantauan jangka panjang dan bila dikombinasikan dengan terapi imunosupresi standar.

Co-Authors Abdullah Reza Agus Susanto Kosasih, Agus Susanto Andreasta Meliala Anggia Widyasari Arwin AP Akib, Arwin AP Aryono Hendarto Aulia Fitri Swity Badriul Hegar Cut Nurul Hafifah Dian Puspita Sari Djajadiman Gatot Djajadiman Gatot Djajadiman Gatot Eka Laksmi Hidayati, Eka Laksmi Endang Windiastuti Endang Windiastuti Fifi Dwijayanti Firman Gitta Reno Cempako Harahap, Alida Roswita Hartono Gunardi Haryanti Fauziah Wulandari Hikari Ambara Sjakti, Hikari Ambara Hindra Irawan Satari Ifran, Evita Kariani Irawan Mangunatmadja Iskandar, Stephen Diah Ismi Citra Ismail Kemas Firman Kuntjoro Harimurti Ludi Dhyani Rahmartani Murti Andriastuti, Murti Mururul Aisyi Muzal Kadim Novie Amelia Chozie Nur Aliza Ponpon S Idjradinata Pustika Amalia Wahidiyat Pustika Amalia Wahidiyat, Pustika Amalia Riski Muhaimin Rismala Dewi Rosalina Dewi Roeslani, Rosalina Dewi Saputra, Fahreza Sarwono Waspadji Septiana, Mega Setyanto, Darmawan Budi Simanjuntak, Sumardi F. Siti Ayu Putriasih Soedjatmiko Sri Rezeki S Hadinegoro, Sri Rezeki S Stephen Diah Iskandar Sukman Tulus Putra Titis Prawitasari, Titis Umam Fazlurrahman Utomo, Ahmad Rusdan Handoyo Yoga Devaera Yosia, Mikhael Yvan Vandenplas

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