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All Journal Jurnal Kedokteran Brawijaya Medical Journal of Indonesia Sari Pediatri Paediatrica Indonesiana World Nutrition Journal

Zakiudin Munasir

Departemen Ilmu Kesehatan Anak Universitas Indonesia, Jakarta

Author-ID : 3453007

Health Professions Medicine & Pharmacology Public Health

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Correlation between urinary albumin to creatinine ratio and systemic glycocalyx degradation in pediatric sepsis Saragih, Rina A.C.; Pudjiadi, Antonius H.; Tambunan, Taralan; Satari, Hindra I.; Aulia, Diana; Bardosono, Saptawati; Munasir, Zakiudin; Lubis, Munar
Medical Journal of Indonesia Vol 27, No 3 (2018): September
Publisher : Faculty of Medicine Universitas Indonesia

Background: Increased capillary permeability in sepsis is associated with several complications and worse outcomes. Glycocalyx degradation, marked by increased serum syndecan-1 levels, alters vascular permeability, which can manifest as albuminuria in the glomerulus. Therefore, elevated urinary albumin to creatinine ratio (ACR) potentially provides an index of systemic glycocalyx degradation. The aim of this study was to analyze the correlation between urinary ACR and serum syndecan-1 levels.Methods: A longitudinal prospective study with repeated cross-sectional design was conducted on children with sepsis in pediatric intensive care unit, we evaluated serum syndecan-1 levels and urinary ACR on days 1, 2, 3, and 7. A descriptive study on healthy children was also conducted to determine the reference value of syndecan-1 in children.Results: 49 subjects with sepsis were recruited. Based on the data of the healthy children group (n=30), syndecan-1 level of >90th percentile (41.42 ng/mL) was defined as systemic glycocalyx degradation. The correlation coefficients (r) between urinary ACR and syndecan-1 levels were 0.32 (p<0.001) from all examination days (162 specimens), 0.298 (p=0.038) on day 1, and 0.469 (p=0.002) on day 3. The area under the curve of urinary ACR and systemic glycocalyx degradation was 65.7% (95% CI 54.5%–77%; p=0.012). Urinary ACR ≥157.5 mg/g was determined as the cut-off point for glycocalyx degradation, with a sensitivity of 77.4% and a specificity of 48%.Conclusion: Urinary ACR showed a weak correlation with systemic glycocalyx degradation, indicating that the pathophysiology of elevated urinary ACR in sepsis is not merely related to glycocalyx degradation.

FAKTOR YANG DIDUGA MENJADI RESIKO PADA ANAK DENGAN RINITIS ALERGI DI RSU DR. CIPTO MANGUNKUSUMO JAKARTA Harsono, Ganung; Munasir, Zakiudin; Siregar, Sjawitri P; Suyoko, HEM Dadi; Kumiati, Mia; Evalina, Rita; Palupi, Ratih D
Jurnal Kedokteran Brawijaya Vol 23, No 3 (2007)
Publisher : Fakultas Kedokteran Universitas Brawijaya

This researach was aimed to describe the risk factor profile of pediatric patients with allergic rhinitis. 1792 medical recordsof outpatients pediatric allergy immunology clinic in Cipto Mangunkusumo Hospital from 1997 to 2005. Fifty patients wereÂ diagnosed with allergic rhinitis and 22% of them Â were having allergic rhinitis with bronchial asthma.Allergic rhinitis wereÂ identified higher in boys (62%) than girls (38%) and ranged from 5 months to 13 years and 8 months old. Atopic historyÂ were identified in 24 patients (48) while atopic history in patient family were identified in mother (42%), father (40%), andÂ siblings (24%). Total IgE serum increased in 35 patients (88,57%) while total eosinophil serum increased in 28 patientsÂ (80%). The most common aeroallergen by skin prick test was house dust mite (36%) and the most common food allergenÂ was shrimp (40%). There were several factors that contribute to the development of allergic rhinitis such as age, sex,Â family atopic history and increasing in total IgE serum and total eosinophil serum . House dust mite and shrimp were theÂ most common allergen identified in allergic rhinitis.Â Keywords: allergic rhinitis, risk factors, pediatric

Economic value of atopic dermatitis prevention via partially-hydrolyzed whey-based infant formula (PHF-W) use in high-risk, non-exclusively breastfed, Indonesian urban infants: results of a cost-effectiveness model Marc F Botteman; Zakiudin Munasir; Astrid W Sulistomo; Erica G Horodniceanu; Abhijeet J Bhanegaonkar; Xiang Ji; Wing Yu Tang; Ray Wagiu Basrowi; Patrick Detzel
World Nutrition Journal Vol. 2 No. 2 (2019)
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/WNJ.V02.i2.0008

Background: Early nutritional intervention with partially-hydrolyzed whey-based formula (PHF-W) instead of standard cow’s milk formula (CMF) has been found to reduce the risk of atopic dermatitis (AD) development in non-exclusively breastfed infants with familial heredity of AD.Objective: To estimate the 6-year economic impact of this nutritional intervention in non-exclusively breastfed Indonesian urban infants with family history of AD.Methods: A mathematical model simulated AD incidence and burden of using PHF-W vs. CMF in the target population from birth to age 6. The model integrated literature, current cost and market catalogues, and expert clinician opinion. Modeled outcomes included AD risk, time spent post-AD diagnosis, days without flare, quality-adjusted life-years, and costs.Results: Using PHF-W instead of CMF resulted in an estimated absolute 14% (95% CI: 4%, 23%) AD risk reduction, a 0.69 year (95% CI: 0.26, 1.13) per-child reduction in time spent post-AD diagnosis, a 38 (95% CI: 12, 67) increase in days without AD flare, and a 0.046 gain in quality-adjusted life-years. The AD-related 6-year cost estimates when feeding high-risk urban infants with PHF-W were Indonesian Rupiah (IDR) 8,695,057 (95% CI: IDR 4,519,447, IDR13,995,605) and IDR13,139,569 (95% CI: IDR 7,098,794, IDR 19,216,068) per child, respectively, resulting in a net per-child difference of IDR 4,444,512 (95% CI: IDR1,893,080, IDR 8,557,946) favoring PHF-W.Conclusion: PHF-W for the first 17 weeks of non-exclusively breastfed Indonesian urban infants with a hereditary risk of AD demonstrated a reduction in AD incidence, increased days without flare, and increased quality-adjusted life-years and net cost reductions.

Soy Isolate Protein Formula: the usage beyond allergy indication Zakiudin Munasir; Rini Sekartini
World Nutrition Journal Vol. 4 No. S1 (2020): Soy Plant-based and Fiber in Children’s Gut Health, Growth & Development
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/WNJ.V04.S1.0005

The usage of soy isolate protein formula for infants was recommended by Indonesian Pediatrics Association (IDAI) through the recommendation of Cow’s Milk Protein Allergy (CMPA) management in 2014. Soy Infant Formula (SIF) has been being used for Infants with Cow’s Milk Protein Allergy (CMPA) as well as for several other related medical indications such as post diarrhea lactose intolerance, galactosemia and primary lactase deficiency1. At early stage of soy formula, it had several deficiencies, infant acceptability, growth, and incomparable with milk-base formula. Current SIF is made from soy protein isolate that contain 2,2 – 2,6 g of protein per 100 calories, it is higher than milk-based formula and both showed same growth and development in Infants2. It contains different fibers, phytate, digestibility, protease inhibitor and proteins. SIF is easily digestible and contain high amino acid content fortified with L-methionine, L-carnitine and taurine. High content of phytate is overcome with zinc and iron fortification as well as increased levels of calcium and phosphor3. American Academy of Pediatrics recommends isolated soy protein-based formulas as a safe and effective alternative for providing appropriate nutrition for normal growth and development for term infants whose nutritional needs are not being met from maternal breast milk or cow’s milk-based formulas3,4.

Partially Hydrolyzed Whey Protein: A Review of Current Evidence, Implementation, and Further Directions Badriul Hegar; Zakiudin Munasir; Ahmad Suryawan; I gusti Lanang Sidhiarta; Ketut Dewi Kumara Wati; Erfi Prafiantini; Irene Irene; Yvan Vandenplas
World Nutrition Journal Vol. 5 No. 1 (2021)
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/WNJ.V05.i1.0008

Background: Human milk is known to be the best nutrition for infants as it provides many health benefits. For non-breastfed infants, cow's milk based infant formula is the most optimal option to provide the needed nutrition. However, approximately 2-5% of all formula-fed infants experience cowâ€™s milk allergy during their first year of life. Partially hydrolyzed whey formula (pHF-W) have been widely recommended to prevent the development of allergic disease in infants. However, according to epidemiological data, approximately half of the infants developing allergy are not part of the at-risk group.Objectives and Methods: This article aims to review the effects of pHF-W in preventing allergy, especially atopic disease, in all non-breastfed infants, as well as the safety aspect of pHF-W if used as routine formula. The role of pHF-W in the management of functional gastro-intestinal (GI) disorders is also reviewed.Results: Several clinical studies showed that pHF-W decrease the number of infants with eczema. The strongest evidence is provided by the 15-year follow up of the German Infant Nutritional Intervention study which showed reduction in the cumulative incidence of eczema and allergic rhinitis in pHF-W (OR 0.75, 95% CI 0.59-0.96 for eczema; OR 0.67, 95% CI 0.47-0.95 for allergic rhinitis) and casein extensively hydrolysed formulaÂ group (OR 0.60, 95% CI 0.46-0.77 for eczema; OR 0.59, 95% CI 0.41-0.84 for allergic rhinitis), compared to CMF as a control, after 15 years of follow-up. pHF-W was also found to be beneficial in the management of functional GI disorders such as regurgitation, constipation and colic.Conclusions: The use of pHF-W in allergic infants has been recommended in various guidelines across the countries, as a primary prevention of allergic disease. One pHF-W has been approved by the US FDA and the European Commission's European Food Safety Authority (EFSA) for its safety and suitability as a routine infant formula for all healthy infants. According to the data obtained in the management of functional GI disorders, pHF-W is better tolerated than formula with intact protein. Further studies assessing the effect of routine use of pHF-W in a larger population of non-breastfed infants should also be conducted, in order to observe any potential harm and to determine the benefit and cost-effectiveness ratio.

Immune development of children born from Caesarean section Zakiudin Munasir; Levina Chandra Khoe
World Nutrition Journal Vol. 4 No. S2 (2020)
Publisher : Indonesian Nutrition Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25220/WNJ.V04.S2.0003

Several studies results have shown that mode of delivery affects the health of children, and recent studies showed that elective cesarean section (CS) is associated with aberrant short-term immune responses in the newborn baby and an increased risk of developing immune disorders. This article focused on the effect and role of the C-section on the immune development in children. Begin at pregnancy, the infant's immune system is activated and develops years after birth. In this article we find that cesarean delivery mode will influence the offspring's immune system by disrupting the intestinal tract's bacterial colonization, different levels of birth adaptive stress, and altering gene expression epigenetic regulation. Some studies have found that gut microbiome composition plays a significant role in the development of immune system along with other factors such as diet/lifestyle, antibiotic use, formula feeding, vaccination with life vaccine, and pathogen exposure. In early life, disrupted colonization induced dysbiosis that was associated with lower Bifidobacteria and higher counts of C. difficile. These findings are related to infant immune disease and allergy. Dysbiosis following C-section has a huge effect of developing altered immune system, and this microbiome imbalance can be controlled by nutritional support such as maternal breast milk or the use of different combinations of prebiotics and probiotics (synbiotic) which could be beneficial for the immune and metabolic system.

Pemberian Bubur Formula Protein Hidrolisat dan Bubur Soya dalam Pencegahan Alergi Susu Sapi Zakiudin Munasir; Sjawitri P Siregar; Sri S Nasar; Nia Kurniati
Sari Pediatri Vol 8, No 4 (2007)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp8.4.2007.282-8

Latar belakang. Alergi susu sapi (ASS) sering merupakan penyakit alergi pertama padaseorang bayi. Upaya pencegahan terhadap alergi protein susu sapi berupa pencegahanprimer, sekunder atau tersier.Tujuan. Untuk membandingkan bubur yang mengandung protein susu sapi hidrolisisparsial dengan bubur yang mengandung isolat protein soya sebagai makanan pendampingpada bayi berisiko alergi tinggi terjadinya ASS.Metoda. Penelitian uji klinik acak buta ganda ini dilakukan pada bayi usia 4-6 bulanyang mempunyai bakat atopik dengan pemberian dua jenis bubur yaitu buburhipoalergenik dan bubur soya.Hasil. Didapatkan 84 bayi yang dapat dievaluasi sampai akhir penelitian, terdiri dari47 (56%) bayi laki-laki dan 37 (44%) bayi perempuan. Subyek dibagi menjadi kelompokbubur hipoalergenik (HA) 47 bayi (56%) dan kelompok bubur bubur soya 37 bayi(44%). Sebagian besar evaluasi skor gejala alergi menunjukkan hasil skor yang tidaktimbul atau skor yang menurun, yaitu masing-masing 39 bayi (46,4%) dan 36 bayi(42,9%). Pengukuran kadar IgE spesifik protein susu sapi pada awal dan akhir penelitiansebagian besar menunjukkan hasil negatif, yaitu masing-masing 62 bayi (86,1%) dan 43bayi (70,5%). Tidak ada hubungan yang bermakna antara evaluasi skor gejala alergiantara kedua kelompok bubur, ataupun antara kadar IgE spesifik protein susu sapi padaakhir penelitian pada kedua kelompok bubur yang hanya menggunakan susuhipoalergenik atau ASI.Kesimpulan. Bubur protein soya yang dikombinasi dengan susu hipoalergenik atauASI mempunyai manfaat yang sama dengan bubur hipoalergenik dalam mencegahtimbulnya ASS. Kedua kelompok bubur juga dapat menghasilkan kenaikan berat badandan panjang badan yang sama.

Tata laksana Dermatitis Atopik pada Anak serta Pencegahan Terjadinya Asma di Kemudian Hari Zakiudin Munasir
Sari Pediatri Vol 4, No 3 (2002)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp4.3.2002.119-24

Konsep allergic march saat ini banyak dipakai dalam pencegahan dini timbulnya penyakitalergi pada anak yang lahir dari keluarga atopik. Gejala alergi yang paling sering padabayi usia dini adalah alergi makanan dengan manifestasi dermatitis atopik. Beberapajenis makanan yang mencetuskan dermatitis atopik antara lain susu sapi, telur, ikanlaut, kacang tanah, tomat, jeruk dan coklat. Diet eliminasi makanan alergen utamapada ibu menyusui dapat mencegah timbulnya penyakit alergi di kemudian hari padabayi yang disusui. Penanganan pasien dermatitis atopik relatif sulit. Walaupun demikian,dengan tata laksana yang adekuat dengan kerjasama yang baik antara dokter, pasien dankeluarganya kelainan ini dapat diatasi. Secara garis besar, pengobatan dermatitis atopikmeliputi penghindaran bahan iritan, faktor pencetus, mengatasi rasa gatal dan kekeringankulit serta mengatasi reaksi peradangan dan infeksi sekunder. Pengobatan pencegahandini dengan menggunakan setirisin pada anak dengan dermatitis atopik dilaporkan dapatmenurunkan risiko terjadinya asma di kemudian hari.

Sensitisasi Alergen Makanan dan Hirupan pada Anak Dermatitis Atopik Setelah Mencapai Usia 2 Tahun Sondang Sidabutar; Zakiudin Munasir; Aman B Pulungan; Aryono Hendarto; Alan R Tumbelaka; Kemas Firman
Sari Pediatri Vol 13, No 2 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Latar belakang. Dermatitis atopik (DA) merupakan manifestasi awal atopic marchyang berhubungan dengan alergi makanan. Alergen penyebab dan faktor risiko yang memengaruhi penting diketahui. Tujuan. Mengetahui sensitisasi dan faktor risiko alergi pada DA setelah usia 2 tahun. Metode. Penelitian deskriptif potong lintang terhadap 35 subjek DA sejak Januari-Maret 2011. Sensitisasi diketahui dengan uji tusuk kulit. Hasil. Sensitisasi terjadi pada 29 subjek dari 35 subjek, dengan faktor risiko pajanan asap rokok ditemukan pada 21 subjek, faktor risiko alergi sedang dan tinggi 19 subjek, tidak mendapat ASI eksklusif 9 subjek, dan makanan padat usia dini 21 subjek. Sensitisasi alergen makanan ditemukan pada 26 subjek.Kesimpulan. Sebagian besar subjek DA mengalami sensitisasi oleh alergen makanan. Faktor risiko pajanan asap rokok, faktor risiko alergi sedang dan tinggi, tidak mendapat ASI eksklusif, dan mendapat makanan padat usia dini ditemukan lebih sering pada anak DA

Insidens dan Faktor Risiko Hipotermia Akibat Memandikan pada Bayi Baru Lahir Cukup Bulan Irma Rochima Puspita; Rulina Suradi; Zakiudin Munasir
Sari Pediatri Vol 8, No 4 (2007)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp8.4.2007.258-64

Latar belakang. Mandi merupakan salah satu paparan dingin pada bayi baru lahiryang dapat menyebabkan hipotermia. Data mengenai insidens dan faktor risikohipotermia akibat memandikan bayi baru lahir di Puskesmas atau di rumah bersalinsampai saat ini belum ada. Hasil pengamatan awal yang dilakukan di sebuah Puskesmasdan sebuah rumah bersalin swasta didapatkan sebesar 50% bayi baru lahir mengalamihipotermia sesudah mandi.Tujuan Penelitian. Penelitian ini bertujuan untuk mengetahui insidens dan faktorrisiko hipotermia akibat memandikan pada bayi baru lahir cukup bulan setelahmendapatkan penyuluhan tentang hipotermia.Metoda. Penelitian ini adalah studi kohort prospektif pada bayi baru lahir cukup bulandan sehat yang dimandikan saat usia lebih dari 6 jam. Bayi dimandikan dengan caraseluruh tubuh bayi dibasahi dengan air hangat dan dibersihkan dengan sabun bayi,kemudian seluruh tubuh bayi dimasukkan ke dalam bak mandi. Suhu aksila tubuh diukurdengan termometer digital. Suhu ruangan diukur dengan termometer digital, suhu airmandi diukur dengan termometer air raksa dan lama mandi diukur dengan stopwatch.Sebelum penelitian berlangsung, kepada petugas kesehatan setempat telah diberikanpenyuluhan mengenai hipotermia dan persiapan mandi yang baik.Hasil. Subyek penelitian adalah 100 bayi terdiri dari 53 bayi lahir di Puskesmas dan 47 bayilahir di RB swasta. Insidens hipotermia di Puskesmas lebih tinggi yaitu sebesar 49%dibandingkan dengan insidens di RB swasta sebesar 25,5% (RR 1,79; IK 95% 1,07; 3,00, p= 0,016). Insidens hipotermia pada bayi yang dimandikan pagi hari lebih sering (44%)dibandingkan dengan yang dimandikan sore hari (28%), namun secara statistik tidakbermakna (RR = 1,57; IK 95% = 0,88;2,79, p = 0,107). Faktor risiko hipotermia adalahsuhu aksila segera sebelum mandi (r = 0,73, p = 0,000) dan suhu air mandi (r = 0,73, p =0,008). Suhu aksila segera sebelum mandi dan suhu air mandi yang aman untuk memandikanbayi baru lahir berusia lebih dari 6 jam adalah berturut-turut 37,25Â°C dan 35Â°C.Kesimpulan. Terjadi penurunan insidens hipotermia setelah mendapatkan penyuluhan tentangpersiapan mandi yang baik, dari 50% pada awal pengamatan menjadi sebesar 49% di Puskesmasdan 25,5% di rumah bersalin swasta. Faktor risiko yang berkorelasi dengan hipotermia akibatmemandikan bayi cukup bulan lebih dari 6 jam sesudah lahir adalah suhu aksila segera sebelummandi dan suhu air mandi. Suhu aksila segera sebelum mandi dan suhu air mandi yang amanuntuk mencegah hipotermia adalah berturut-turut masing-masing 37,25Â°C dan 35Â°C.

Co-Authors Abhijeet J Bhanegaonkar Agus Firmansyah Ahmad Suryawan Alan R Tumbelaka Alan R. Tumbelaka Alan Roland Tumbelaka Aman B Pulungan Amy Diana Ruth Anang Endaryanto Antonius H. Pudjiadi, Antonius H. Arini Setiawati Arwin A.P. Akib Arwin A.P. Akib Arwin AP Akib Arwin AP Akib Aryono Hendarto Astrid W Sulistomo Badriul Hegar Bambang Supriyatno Bambang Supriyatno Bambang Tridjaja Bernie Endyarni Medise Bertha Soegiarto Budi Setiabudiawan Caroline Mulawi Corry S Matondang Corry S. Matondang Dewi Kartika Suryani Diana Aulia Dina Muktiarti Dina Muktiarti Dina Muktiarti Dina Muktiarti Djajadiman Gatot Ellen P. Gandaputra EM Dadi Suyoko Endang Windiastuti Erfi Prafiantini Erica G Horodniceanu Fatima Safira Alatas Ferry Damardjati S.P. Ganda Ilmana Ganung Harsono Graham RR Hanifah Oswari Hardiono D. Pusponegoro HEM Dadi Suyoko Hindra I. Satari Hindra I. Satari, Hindra I. Hindra Irawan Satari Hindra Irawan Satari I Boediman I gusti Lanang Sidhiarta Imral Chair Irene Irene Irma Rochima Puspita Johannes Hudyono Jose R. L. Batubara Jose RL Batubara Julfina Bisanto Kemas Firman Ketut Dewi Kumara Wati Levina Chandra Khoe Lily Irsa Marc F Botteman Maria Abdulsalam Melissa Gandi Melva Louisa Mia Kumiati Miesien Miesien Molly D. Oktarina Mulya Rahma Karyanti Mulya Safri Mulya Safri Mulyadi Mulyadi Munar Lubis, Munar Ni Putu Sudewi Nia Kuniati Nia Kurniati Nia Kurniati Nia Kurniati Nia Kurniati Nia Kurniati Nita Ratna Dewanti Novie Amelia Chozie Patria Vittarina Sarisetyaningtyas Patrick Detzel Qatrah D. Seprida Ratih D Palupi Ratih Dewi Palupi Ray Wagiu Basrowi Rina A.C. Saragih, Rina A.C. Rinawati Rohsiswatmo Rini Sekartini Rita Evalina Rulina Suradi Rulina Suradi Saptawati Bardosono Siti D. Wisnuwardhani Sjawitri P Siregar Sjawitri P Siregar Sjawitri P Siregar Sjawitri P. Siregar Sondang Sidabutar SRI LESTARI Sri Rezeki Hadinegoro Sri S Nasar Sudung O. Pardede Sumadiono Sumadiono Syawitri P Siregar Taralan Tambunan Taralan Tambunan Tina W. Wisesa Wardhana Wardhana Wing Yu Tang Xiang Ji Yvan Vandenplas

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