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All Journal Sari Pediatri Paediatrica Indonesiana Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute

Mulya Rahma Karyanti, Mulya Rahma

Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo

Author-ID : 3210240

Health Professions Medicine & Pharmacology Neuroscience Public Health

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Clinical manifestations and hematological and serological findings in children with dengue infection Mulya Rahma Karyanti
Paediatrica Indonesiana Vol 51 No 3 (2011): May 2011
Publisher : Indonesian Pediatric Society

Background Dengue hemorrhagic fever (DHF) is endemic toÂ Indonesia and remains a public health problem, with its highestÂ incidence in children. There have been few reports on the clinical,Â hematological and serological data in children \\lith dengue.Objective To assess the clinical and laboratory profiles of childrenÂ \\lith dengue infection in Cipto Mangunkusumo Hospital, Jakarta,Â Indonesia.Methods Clinical, hematological and serological infonnation fromÂ children diagnosed v.ith dengue infection in Cipto MangunkusumoÂ Hospital were collected from 2007 to 2009.Results Of611 children admitted with dengue, 143 (23.4%) hadÂ dengue fever (DF), 252 (41.2%) had DHF grades I and II; andÂ 216 (35.4%) had DHF grades III and IV. Of the 81 cases whereÂ dengue serotypes were identified, 12.3% were DENV1, 35.8%Â were DENV-2, 48.2% were DENV-3 and 3.7% were DENV-4.Â Mean age of subjects was 8.9 years (SD 4.4), and 48.4% of casesÂ were boys. The mean length of fever before hospital admissionÂ was 4.2 days (SD 1.1) and mean length of stay in the hospital wasÂ 4 days (SD 2.7). Common symptoms observed were petechiae,Â hepatomegaly and epistaxis. Complications found mostly in thoseÂ with dengue shock syndrome (DSS) were hematemesis (30 cases,Â 4.9% of all patients), encephalopathy (19 cases, 3.1 %) and melenaÂ (17 cases, 2.8%).Conclusion Signs and symptoms of fever, bleeding manifestationsÂ and thrombocytopenia were present in children 'With DF and DHF,Â while signs of increased vascular permeability were found only inÂ those 'With DHF. Encephalopathy and gastrointestinal bleedingÂ were found mostly in DSS cases. At admission, leukopenia wasÂ found in more DF patients than in DHF patients. AbsenceÂ of leukopenia may be a sign of more severe dengue infection.Â

The effect of Ringerâ€™s acetate versus Ringerâ€™s lactate on aminotransferase changes in dengue hemorrhagic fever Mulya Rahma Karyanti; Hindra Irawan Satari; Damayanti Rusli Sjarif
Paediatrica Indonesiana Vol 45 No 2 (2005): March 2005
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi45.2.2005.81-6

Background Dengue hemorrhagic fever (DHF) infection causeshepatocelullar impairment. In management of DHF, World HealthOrganization (WHO) recommends the crystalloids Ringerâ€™s acetate(RA) or Ringerâ€™s lactate (RL), which are similar in composition toplasma. Acetate in RA is not metabolized in the liver, hence notburdening the liver, whereas lactate in RL is metabolized mostly inthe liver, thus placing a burden on the liver.Objective To compare aminotransferase changes as markers ofhepatocellular impairment subsequent to the use of RA and RL inthe management of DHF with and without shock.Methods This study was a double-blind randomized controlledtrial on DHF patients aged 1-18 years in Cipto MangunkusumoHospital who had not received prior treatment with crystalloids orcolloids. Subjects were randomly assigned to receive either RA orRL intravenously. Aminotransferase levels were examined on thefirst, second and third weeks from the onset of fever.Results Ninety-two patients who fulfilled inclusion criteria wereenrolled in this study, consisting of those without and with shock.Mean transaminase levels of patients without shock in the RA andRL groups did not differ significantly. Mean transaminase levels ofpatients with shock in the RA group were lower than those in theRL group, but this difference was not significant statistically. Meanalteration of transaminase levels in patients with and without shockwere not significantly different.Conclusion In DHF without shock, there is no significant differ-ence between aminotransferase level changes of patients receiv-ing RA and RL solutions. In DHF with shock, aminotransferaselevels of patients receiving RA tend to be lower than those receiv-ing RL, but this difference is insignificant

A comparison of axillary and tympanic membrane to rectal temperatures in children Tania Paramita; Mulya Rahma Karyanti; Soedjatmiko Soedjatmiko; Aryono Hendarto; Dadi Suyoko; Abdul Latief
Paediatrica Indonesiana Vol 57 No 1 (2017): January 2017
Publisher : Indonesian Pediatric Society

Background Core body temperature measurement is not commonly done in pediatric populations because it is invasive and difficult to perform. Therefore, axillary and tympanic membrane temperature measurements are preferable, but their accuracy is still debatable.Objective To compare the accuracy of axillary and tympanic temperatures to rectal temperature in children with fever, and to measure the cut-off point for fever based on each temperature measurement method.Methods A diagnostic study was conducted among feverish children aged 6 months to 5 years who were consecutively selected from the Pediatric Outpatient Clinic, Pediatric Emergency Unit, and the inpatient ward in the Department of Child Health, Cipto Mangunkusumo Hospital (CMH), from December 2014 to January 2015. Subjects underwent three measurements within a two minute span, namely, the axillary, tympanic membrane, and rectal temperature measurements. The values obtained from the examination were analyzed with appropriate statistical tests.Results The cut-off for fever on axilla was 37.4oC and on tympanic membrane wasÂ 37.4oC, with sensitivity 96% (95%CI 0.88 to 0.98) and 93% (95%CI 0.84 to 0.97), respectively; specificity 50% (95%CI 0.47 to 0.84) and 50% (95%CI 0.31 to 0.69), respectively; positive predictive value/PPV 90% (95%CI 0.81 to 0.95) and 85% (95%CI 0.75 to 0.91), respectively; and negative predictive value/NPV 83% (95%CI 0.61 to 0.94) and 69% (95%CI 0.44 to 0.86), respectively. The optimal cut-off of tympanic membrane and axilla temperature was 37.8oC (AUC 0.903 and 0.903, respectively).Conclusion Axillary temperature measurement is as good as tympanic membrane temperature measurement and can be used in daily clinical practice or at home. By increasing the optimum fever cut-off point for axillary and tympanic membrane temperature to 37.8oC, we find sensitivity 81% and 88%, specificity 86% and 73%, PPV 95% and 91%, and NPV 95% and 91%, respectively.Â

Hepatitis B seroprotection in children aged 10-15 years after completion of basic hepatitis B immunizations Novie Homenta Rampengan; Sri Rezeki Hadinegoro; Mulya Rahma Karyanti
Paediatrica Indonesiana Vol 57 No 2 (2017): March 2017
Publisher : Indonesian Pediatric Society

Background The prevalence of hepatitis B viral (HBV) infection in Indonesia is high. The most effective way to control HBV infection is by hepatitis B (HB) immunization. Many studies reported that hepatitis B surface antibody (anti-HBs) seroprotection declines in children > 10 years of age. In addition many factors can influence anti-HBs titer.Objective To measure anti-HBs titer and evaluate possible factors associated with anti-HBs titer.Methods This cross sectional Â study was conducted in children 10-15 years of age from ten schools at Tuminting District, Manado, North Sulawesi, from October to November 2014. All subjects had completed the hepatitis B immunization scheme. By stratified random sampling, 105 children were selected as subjects. Data was analyzed with SPSS version 22.Results. From 48 schools, we selected 10 schools from which to draw a total of 105 children, but only 23 (21.9%) children had detectable anti-HBs . Of all subjects, 76 (72.4%)Â were female, 78 (74.3%)Â had good nutritional status, and 98 (93.3%)Â had birth weight â‰¥2,500 grams. Data from immunization record books showed that 26 (24.8%) subjects received the HB-1 vaccination at â‰¤7 days of age and 45 (42.9%) subjects had a â‰¥2 month interval between the HB-2 and HB-3 vaccinations. Multivariate analysis showed that administration of HB-1 at â‰¤7 days of age Â and a â‰¥2 month interval between HB-2 and HB-3 Â had significant associations with anti-HB seroprotection in children.Conclusion A low proportion of subjects who had completed the hepatitis B immunization scheme had detectable anti-HBs titer (21.9%). Administration of HB-1 at â‰¤7 days of age and a â‰¥2-month interval between HB-2 and HB-3 vaccinations are important factors in anti-HB seroprotection in children aged 10-15 years.

Side effects of long-term antiepileptic drugs on renal tubules of Indonesian children Partini Pudjiastuti Trihono; Deasy Grafianti; Irawan Mangunatmadja; Mulya Rahma Karyanti
Paediatrica Indonesiana Vol 58 No 2 (2018): March 2018
Publisher : Indonesian Pediatric Society

Background Long-term treatment with antiepileptic drugs such as valproic acid (VPA) and carbamazepine (CBZ) may disrupt renal tubular function. Urinary N-acetyl-beta-D-glucosaminidase (NAG) may reflect tubular function and may be useful in detecting early-stage tubular injury. To date, no study has investigated the toxic effect of VPA and CBZ on renal tubules using urinary NAG in Indonesian children. Objectives To determine the toxicity of long-term VPA and/or CBZ treatment on renal tubules in children with epilepsy by measuring urinary NAG index (iNAG). Methods This cross-sectional study was conducted from January to March 2015 at Cipto Mangunkusumo Hospital and Anakku Clinic Pondok Pinang, Jakarta. We included children aged 3 to 16 years with epilepsy on VPA (n=36), CBZ (n=14), or VPA-CBZ combination (n=14) therapy. We measured urinary levels of creatinine and NAG. The urinary NAG reference value was obtained from age-matched healthy controls (n=30). To eliminate diurnal variations in NAG, iNAG was calculated by dividing urinary NAG by urinary creatinine. A urinary iNAG of more than two standard deviations above the mean for healthy children was considered elevated. Results Mean urinary iNAG values for the control, VPA, CBZ, and combination groups were 3.01, 5.9, 4.07, and 6.9 U/g, respectively. All treated groups had higher mean urinary iNAG values compared to the control group. Urinary iNAG was increased in 11/36 children on VPA, 2/14 children on CBZ, and 9/14 children on combination therapy. Conclusion Long-term VPA use may impair renal tubular function, as shown by the increased urinary iNAG. Combination therapy increases damage in the renal tubules.

Effects of probiotic on gut microbiota in children with acute diarrhea: a pilot study Dion Darius Samsudin; Agus Firmansyah; Eka Laksmi Hidayati; Irene Yuniar; Mulya Rahma Karyanti; Rosalina Dewi Roeslani
Paediatrica Indonesiana Vol 60 No 2 (2020): March 2020
Publisher : Indonesian Pediatric Society

Background Acute diarrhea is a common health problem in Indonesia. During acute diarrhea, changes in gut microbiota are marked by decrease beneficial microbes Bifidobacterium and Lactobacillus, and increased pathogenic bacteria Enterobacter and Clostridium. Such microbial imbalances are known as dysbiosis. Treatment with probiotics may help repair dysbiosis, quicken healing time, and decrease complications. Objective To assess for dysbiosis during acute diarrhea, and determine if it can be normalized by probiotic treatment. Methods This placebo-controlled, unblinded clinical trial was performed in Budhi Asih District Hospital, Jakarta, from January to March 2018. Twenty-four children age 6-24 months with acute diarrhea and 12 healthy children were enrolled. First fecal specimen was collected for all subjects and analyzed using non-culture real time PCR to count the population of Lactobacillus, Bifidobacterium, Enterobacter, Clostridium, and all bacteria. Children with diarrhea were assigned to probiotic or placebo treatment for 5 days and the second fecal specimen was analyzed two weeks after the diarrhea subsided. Results Prior to treatment, significant higher amounts of Lactobacillus were observed in children with acute diarrhea than in healthy controls [median (interquartile range/IR): 1.52x103 (1.22x104) vs. 6.87x10 (2.41x102), respectively; proportion in percentage (from total bacteria population): 0.044% vs. 0.003%, respectively]. However, median (IR) Clostridium was significantly higher in healthy controls than in children with acute diarrhea [2.37x102 (4.64x103) vs. 4.67 (1.50x102), respectively (P<0.05), with proportion of 0.01% vs. 0.0001%, respectively]. Children who received probiotics had significantly higher count of Bifidobacterium compared to the placebo group [1.94x104 (4.97x104) vs. 1.74x103 (2.08x107), respectively, with proportion of 0.394% vs. 0.081%, respectively]. Conclusion This pilot study do not find evidence of dysbiosis in children with acute diarrhea. Group who received probiotic had higher Bifidobacterium count compared towards those who received placebo.

Atypical cinical manifestation of leprosy in Indonesian male adolescent: a case report Dion Darius Samsudin; Mulya Rahma Karyanti
Paediatrica Indonesiana Vol 61 No 3 (2021): May 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.3.2021.175-8

Leprosy, also known as Hansen’s disease, is a chronic infectious disease with high prevalence, but often neglected in Indonesia. Indonesia ranks the 3rd worldwide, after India and Brazil, with 17,439 new cases reported in 2019.1 This disease is caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus, which mainly affects the skin, peripheral nerves, upper respiratory tract mucosa, and eyes. Early diagnosis of the disease is fundamental, because delayed treatment may lead to severe deformities and disabilities.2 The current multidrug treatment (MDT) for leprosy is widely available in Indonesia for free. According to the World Health Organization (WHO),1 leprosy is one of 20 diseases recognised as neglected tropical diseases (NTDs), a group of disease which present significant burden amongst the poorest, often unheard communities. Eradication of leprosy is challenging because of the difficulty in diagnosis, as leprosy imitates various diseases, as well as treatment delay, high transmission, and social stigma. The regions of highest leprosy prevalence in Indonesia are in Java, Sulawesi, Maluku, and Papua.3,4 Among 17,439 new cases in 2019, 1,861 (10%) were children under 15 years of age.1 The detection of new cases in children indicates high transmission, and lack of mechanisms to control endemic infections.2 The aim of this report is to share our experience in diagnosing advanced stage leprosy with atypical clinical characteristics in a male adolescent.

Antimicrobial activity of homemade WHO ethanol-based hand rub solution in pediatric department, Dr. Cipto Mangunkusumo National Referral Hospital Nina Dwi Putri; Hindra Irawan Satari; Mulya Rahma Karyanti; Ari Prayitno; Pratama Wicaksana; Anis Karuniawati; Delly Chipta Lestari; Nabila Maudy Salma; Shindy Claudya Aprianti; Amalia Almira; Andi Annisa Rusyda Khafiyani
Paediatrica Indonesiana Vol 62 No 4 (2022): July 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.4.2022.232-6

Background Hand hygiene is essential in reducing healthcare-associated infections. Alcohol-based hand rub solutions have been reported to have superior antimicrobial efficacy on both bacteria and lipophilic viruses compared to washing with hand soap. In low- and middle-income countries, the cost of infection control poses a challenge. Our hospital produced an ethanol-based hand rub based on a WHO formulation to reduce the infection prevention costs. Objectives To identify the antimicrobial activity of a WHO ethanol-based hand rub solution against bacterial contamination on the hands of healthcare workers at the Department of Child Health, Dr. Cipto Mangunkusumo National Referral Hospital. Methods This cross-sectional study was performed on the hands of healthcare workers (physicians and nurses) working in the Department of Child Health, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta. A total of 225 specimens from 75 subjects were obtained by collecting swabs on both hands before and after participants worked in the Department of Child Health, Dr. Cipto Mangunkusumo General Hospital. Bacterial culture tests were performed to identify gram-positive and gram-negative bacteria. Bacteria were grouped into no-growth/Bacillus sp, Enterobacteriaceae, cocci, and non-fermenter groups. Results The use of our WHO ethanol-based hand rub solution, generally resulted in a statistically significant decrease in bacterial growth from 84 to 54.6%, before compared to after the hand rub was performed. In more detail, there was a 72.7% decrease in Enterobacteriaceae, a 71.4% decrease in non-fermenters, an 8.6% decrease in cocci and a 44.1% increase in the number of specimens showing no growth bacteria/Bacillus sp. Conclusion Our WHO ethanol-based hand rub has significant antimicrobial activity for common nosocomial pathogens (e.g., Staphylococcus aureus, P. aeruginosa, and K. pneumoniae).

The clinical and biomarker approach to predict sepsis mortality in pediatric patients Irene Yuniar; Mulya Rahma Karyanti; Nia Kurniati; Desti Handayani
Paediatrica Indonesiana Vol 63 No 1 (2023): January 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1.2023.37-44

Background Sepsis is a leading cause of pediatric morbidity and mortality. The prevalence of sepsis mortality in Indonesia varies between 22.5 to 52%. Objective To identify the clinical criteria for predicting sepsis mortality and evaluate the performance of the PELOD-2 score. Methods This retrospective cohort study included pediatric patients admitted to the emergency department or pediatric intensive care unit (PICU) of Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2015 to May 2020. Demographic characteristics (age and sex), clinical manifestations [nutritional status, presence of shock, need for intubation, source of infection, inotrope use, mean arterial pressure, pulse rate, respiratory rate, and Glasgow Coma Scale (GCS) score], laboratory [leukocyte, platelet, neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte count ratio (NLCR), procalcitonin, C-reactive protein (CRP), and lactate profile], PELOD-2 score, and mortality data were recorded as outcomes. Results We analyzed data from 241 sepsis subjects. The overall mortality rate was 65%. Shock [OR 3.2 (95%CI 1.80 to -5.55, P<0.001)], GCS <9 [OR 2.4 (95%CI 1.30 to 4.23, P=0.005)], inotrope use [OR 3.1 (95%CI 1.74 to 5.5, P<0.001)], CRP >33.5 mg/L [OR 2.5 (95%CI 1.14 to 5.35, P=0.02)], and lactate level >2.85 [OR 2.1 (95%CI 1.02 to 4.56, P=0.04)] were considered significant predictors of mortality. A PELOD-2 cut-off score of >8 had optimal sensitivity (81.2%) and specificity (72.9%) to predict mortality, with an OR of 11.6 (95%CI 5.72 to 23.5, P<0.001). Conclusion Shock, GCS score, inotrope use, CRP, and lactate level can serve as clinical biomarkers to predict mortality in pediatric sepsis. A PELOD-2 score of >8 can predict mortality with reasonably good sensitivity and specificity.

H1N1pdm09 infection in children: A case report of reemerging disease in COVID-19 pandemic Puspaningtyas, Niken Wahyu; Nagrani, Dimple Gobind; Karyanti, Mulya Rahma; Fauzie, Rifan; Imanadhia, Ashfahani; Sarita, Raisa Cecilia; Putra, Reynaldo Rahima
Paediatrica Indonesiana Vol 64 No 4 (2024): July 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.4.2024.363-8

An outbreak of H1N1 infection was first declared by the World Health Organization in 2009 and confirmed in the post-pandemic phase in 2010. Amid the COVID-19 pandemic, we found a confirmed case of H1N1pdm09 in Bunda Women and Children Hospital Jakarta. A 13-year-old boy was referred to our hospital after four days of hospitalization due to worsening tachypnea following a productive cough and fever. The patient had severe dyspnea with inspiratory effort and oxygen desaturation to 80%, therefore admitted to our pediatric intensive care unit. On physical examination, the patient had increased work of breathing, looked irritable, had a respiratory rate of about 40x/minute with non-rebreathing mask support, and crackles were heard in both lungs. Chest x-ray showed right bronchopneumonia. There was a history of a generalized seizure for less than 1 minute, which stopped spontaneously in previous hospital care. The patient was diagnosed with mucopolysaccharidosis at age six years old and has never received enzyme replacement therapy. Laboratory results revealed thrombocytopenia, leukopenia, neutrophilia, monocytosis, high c-reactive protein and procalcitonin, and elevated liver enzymes. The investigation of etiology was performed using the respiratory panel test and showed a positive real-time polymerase chain reaction for H1N1pdm09 and Influenza A. The patient was given oxygen therapy with a high-flow nasal cannula with an oxygen fraction of 40% and a flow of 20 liters per minute, fluid maintenance while fasting, antibiotics, inhaled beta-2 agonists, and a neuraminidase inhibitor (oseltamivir). The patient's clinical and laboratory markers improved on the third day of treatment, and he was discharged two days later.

Co-Authors Abdul Latief Agus Firmansyah Amalia Almira Andi Annisa Rusyda Khafiyani Anggraini Alam Anis Karuniawati Annisa Putri Ari Prayitno Aryono Hendarto Athiyatul Aufie Bambang Supriyatno Dadi Suyoko Damayanti Rusli Sjarif Deasy Grafianti Delly Chipta Lestari Desti Handayani Dewi Kartika Suryani Dewi Murniati Oman Dina Muktiarti, Dina Dion Darius Samsudin Djajadiman Gatot Eka Laksmi Hidayati, Eka Laksmi Hanifah Oswari Hindra Irawan Satari Hindra Irawan Satari Hindra Irawan Satari Hindra Irawan Satari I Wayan Gustawan Imanadhia, Ashfahani Indah S. Widyahening Irawan Mangunatmadja Irene Yuniar Irene Yuniar, Irene Karina Faisha Lucyana Alim Santoso Muhammad Rayyan Faher Shahab Nabila Maudy Salma Nagrani, Dimple Gobind Nanda Asyura Rizkyani Nia Kurniati Nia Kurniati Nia Kurniati Nicolas Gunawan Nina Dwi Putri Novie Homenta Rampengan Novie Homenta Rampengan Partini Pudjiastuti Trihono Partini Pudjiastuti Trihono, Partini Pudjiastuti Pinka Nurashri Setyati Pramita Gayatri Pratama Wicaksana Puspaningtyas, Niken Wahyu Putra, Reynaldo Rahima R. Tedjo Sasmono Rhodia, Lia Rifan Fauzie, Rifan Rizqi Amalia Rosalina Dewi Roeslani Sarita, Raisa Cecilia Shindy Claudya Aprianti Soedjatmiko Sri Rezeki Hadinegoro Sri Rezeki Hadinegoro Sri Rezeki Hadinegoro Sri Rezeki Hadinegoro Sri Rezeki S Hadinegoro Sri Sulastri Katarnida Sudung O Pardede, Sudung O Sukman Tulus Putra Tania Paramita Taralan Tambunan Yessi Yuniarti Yoga Devaera Yusticia Katar Zakiudin Munasir Zakiudin Munasir

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