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All Journal Sari Pediatri Paediatrica Indonesiana Narra J
Amanda Soebadi
Department Of Child Health, Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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The management of febrile seizures by pediatricians in Indonesia: adherence to 2016 Indonesian Pediatric Society recommendations and influencing factors Amanda Soebadi; Rivaldo Suhito; Setyo Handryastuti
Paediatrica Indonesiana Vol 63 No 2 (2023): March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.2.2023.119-28

Abstract

Background Although febrile seizures are generally benign, judicious management is needed to prevent inadequate or excessive management. In 2016, the Indonesian Pediatric Society (IPS) issued Recommendations for the Management of Febrile Seizures, but it is unclear whether pediatricians follow these recommendations in their clinical practice. Objectives To evaluate adherence to the 2016 IPS Recommendations for the Management of Febrile Seizures amongst pediatricians in Indonesia, as well as factors influencing adherence. Methods An anonymous online questionnaire was distributed by e-mail to IPS member pediatricians. We collected data on age, year of completion of pediatric residency or subspecialty training, practice region, type of practice, number of febrile seizure patients managed per month, and history of attending teaching sessions on the recommendations. We scored participants’ adherence to the recommendations in terms of pharmacologic treatment, ancillary testing, and prognosis. We also analyzed the difference in scores according to participant characteristics. Results Of 308 participants, 247 (80%) obtained a total adherence score of 50% or more of the highest possible score. Median total adherence score was 63.2% (range 20.6% to 100%) of the highest possible score. Median adherence scores were significantly higher in pediatricians who were 31 to 60-years-old vs. >60-years-old (64.7% vs. 52.9%, P=0.004), completed their residency training within the past <10 years vs. >10 years (64.7% vs. 61.8%, P=0.034), practiced in hospitals vs. clinics or private practices (61.8% vs. 50.0%, P=0.006), were aware vs. unaware of the recommendations (64.7% vs. 52.9%, P=0.02), and had vs. had not read the recommendations (62.7% vs. 50.0%, P=0.01). Most participants (93.5%) reported the recommendations to be feasible in their settings. Obstacles to implementation included lack of medication availability (8/20), lack of time to read the recommendations (8/20), lack of awareness of the recommendations (2/20), and limited infrastructure (2/20). Conclusions Most pediatricians in Indonesia have moderately good adherence to the 2016 IPS Recommendations for the Management of Febrile Seizures. Awareness of the recommendations needs to be raised further and limitations in medication distribution and infrastructure need to be overcome for better adherence.
Peran Puasa Ramadhan pada Anak dengan Epilepsi: Studi Pendahuluan Achmad Rafli; Ryan Pramana Putra; Irawan Mangunatmadja; Setyo Handryastuti; Amanda Soebadi
Sari Pediatri Vol 25, No 3 (2023)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp25.3.2023.170-3

Abstract

Latar belakang. Pada bulan Ramadhan semua umat Muslim diwajibkan untuk berpuasa, menahan diri untuk tidak makan, minum, atau meminum obat dari terbit hingga tenggelamnya fajar. Keadaan ini akan menimbulkan tantangan baru bagi anak dengan epilepsi yang berpuasa, berupa kontrol frekuensi kejang, perubahan jadwal minum obat, dan kepatuhan minum obat. Berpuasa dapat menyebabkan perubahan metabolisme otak yang berdampak pada peningkatan fungsi otak dalam hal kognitif, peningkatan neuroplastisitas dan ketahanan terhadap cedera dan penyakit. Adanya perubahan metabolisme otak pada saat berpuasa dapat membantu dalam mengontrol kejang pada anak dengan epilepsi.Tujuan. Penelitian ini bertujuan untuk menilai frekuensi kejang dan efek samping pada anak dengan epilepsi yang berpuasa di bulan Ramadhan tahun 2023. Metode. Penelitian ini merupakan penelitian observasional prospektif yang dilakukan selama 1 bulan. Sampel pada penelitian ini merupakan semua anak dengan epilepsi yang berpuasa pada bulan Ramadhan, April 2023. Anak dengan epilepsi yang berpuasa dipantau frekuensi kejang, jadwal minum obat dan kepatuhannya (sebelum dan setelah berpuasa). Hasil. Total pasien pada penelitian ini adalah dua belas (6 laki-laki, 6 perempuan, rentang usia 6-17 tahun). Jenis kejang absans merupakan jenis kejang yang paling banyak (50%). Tujuh pasien mendapatkan antiepilepsi monoterapi (58,33%) dengan variasi pemberian antiepilepsi 1-4 jenis. Frekuensi kejang pada seluruh pasien mengalami penurunan selama puasa Ramadhan dibandingkan dengan satu bulan sebelumnya sebesar 27%. Tidak ada efek samping yang timbul akibat berpuasa dan perubahan jadwal minum obat. Kesimpulan. Puasa Ramadhan bermanfaat menurunkan frekuensi kejang bagi anak dengan epilepsi.
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

Abstract

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.
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.
The School Years Screening Test for Evaluation of Mental Status-Revised (SYSTEMS-R) as a cognitive function screening tool in children with epilepsy Urfianty, Urfianty; Pusponegoro, Hardiono Djuned; Alatas, Fatima Safira; Soebadi, Amanda; Ramli, Yetty
Paediatrica Indonesiana Vol. 64 No. 5 (2024): September 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.5.2024.377-83

Abstract

Background Children with epilepsy are at high risk of cognitive impairment that can affect quality of life. Intelligence quotient (IQ) measurement using the Wechsler Intelligence Scale for Children (WISC) is the gold standard test of cognitive function, but it is time-consuming and costly. The School Years Screening Test for Evaluation of Mental Status-Revised (SYSTEMS-R) is a potential cognitive function screening tool that can be used in children with epilepsy. Objective To assess the performance of SYSTEMS-R as a cognitive function screening tool in children aged 6-15 years with epilepsy. Methods This cross-sectional diagnostic test study was conducted in children aged 6-15 years with epilepsy. All subjects were assessed using both SYSTEMS-R and WISC 4th edition. The sensitivity, specificity, positive and negative predictive value, likelihood ratios of the positive and negative tests, and accuracy of SYSTEMS-R was calculated, with WISC as the gold standard test. Results Based on the SYSTEMS-R, the prevalence of cognitive impairment in children aged 6-15 years with epilepsy in our population was 86.4%. With WISC as the gold SYSTEMS-R had 84% sensitivity, 91% specificity, 98% positive predictive value, and 47% negative predictive value. The likelihood ratio of a positive SYSTEMS-R test was 10.11 and the likelihood ratio of a negative test was 0.17. The overall accuracy of SYSTEMS-R to detect cognitive impairment was 85%. Conclusion SYSTEMS-R has good sensitivity and specificity to assess cognitive function in children 6-15 years with epilepsy. It can be considered for widespread use in the early detection of cognitive impairment in pediatric epilepsy patients aged 6-15 years.
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.
The collagen type IV alpha 1 chain (COL4A1) mutation as a rare cause of cerebral small vessel disease in adolescent: a case report from Indonesia Achmad Rafli; Indira Rahmawati; Dara Ninggar Santoso; Irawan Mangunatmadja; Setyo Handryastuti; Amanda Soebadi; Fitri Primacakti; Cut Nurul Hafifah; Rakhmad Hidayat; Mohamad Yanuar Amal
Paediatrica Indonesiana Vol. 66 No. 5 (2026): September 2026
Publisher : Indonesian Pediatric Society

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

Abstract

Cerebral Small Vessel Disease (CSVD) is defined as an abnormality of small blood vessels in the brain, including arterioles, venules, or capillaries.1,2 Symptoms of CSVD can be varied, ranging from stroke, cognitive impairment, gait and balance difficulties.3 CSVD can be caused by several factors, such as genetic, environmental, and their combination.4 CSVD is commonly found in adults, and rarely occurs in children or adolescents.1 Genetic mutation is known as the cause of CSVD. Several single-gene disorders causing CSVD are being identified, with several monogenic genes known to contribute, including NOTCH3, HTRA1, COL4A1, COL4A2, TREX1, APP, CTSA, FOXC1, FOXF2, ADA2, GLA, MTHFR, and HBB.1,4–6 One of the gene mutations found in this case was the COL4A1 gene. COL4A1 gene encodes the collagen type IV alpha-1 chain, which forms type IV collagen together with the COL4A2 gene, located on chromosome 13q34. Together, these genes support the basement membrane protein in blood vessels and other organs. COL4A1 gene is highly expressed in small perforating cerebral arteries. COL4A1 mutations in the brain were recognized as a monogenic cause of CSVD in children.7
Co-Authors Antonius H. Pudjiadi Bernie Endyarni Medise Cut Nurul Hafifah Dara Ninggar Santoso Fitri Primacakti, Fitri Indira Rahmawati Irawan Mangunatmadja Ismy, Jufitriani Merci Monica br Pasaribu Mohamad Yanuar Amal Novie Amelia Chozie Pusponegoro, Hardiono Djuned Rafli, Achmad Rakhmad Hidayat Reza, Maulana Okta Rivaldo Suhito Ryan Pramana Putra Santoso, Dara Ninggar Sari, Teny T. Setyo Handryastuti Urfianty, Urfianty Wicaksono, Yuda Satrio Yetty Ramli Yoga Devaera Yuliarti, Klara