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All Journal Sari Pediatri Paediatrica Indonesiana Cermin Dunia Kedokteran
Chairul Yoel, Chairul
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Health Professions Medicine & Pharmacology Public Health

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Kadar 25-hydroxyvitamin D sebagai penanda sepsis pada anak Tjowanta, Austin Simon; Yoel, Chairul; Lubis, Munar
Sari Pediatri Vol 19, No 3 (2017)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1480.437 KB) | DOI: 10.14238/sp19.3.2017.150-5

Abstract

Latar belakang. Sepsis merupakan penyebab tersering morbiditas dan mortalitas pada anak. Vitamin D memiliki peran pentingdalam mengoptimalkan sistem imun bawaan serta memodulasi respon imun adaptif pada sepsis.Tujuan. Untuk mengevaluasi nilai diagnostik dari kadar 25-hydroxyvitamin D sebagai penanda sepsis pada anak.Metode. Penelitian diagnostik dengan desain potong lintang dilakukan terhadap 50 anak di PICU RSUP Haji Adam Malik dariFebruari sampai Maret 2016. Duapuluh lima anak didiagnosis sepsis dan 25 non sepsis. Kriteria inklusi adalah pasien anak berusia1 bulan sampai <18 tahun. Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif dan negatifdinilai pada penelitian ini.Hasil. Rerata kadar 25-hydroxyvitamin D pada kelompok sepsis (24 ng/mL) relatif lebih rendah dibandingkan dengan kelompoknon sepsis (29,7 ng/mL). Nilai batas ambang kadar 25-hydroxyvitamin D 24 ng/mL. Kami menemukan 15 orang dengan sepsis dan2 orang non sepsis dengan nilai batas ambang ini. Dari uji diagnostik diperoleh sensitivitas 60%, spesifisitas 92%, nilai duga positif88%, nilai duga negatif 70%, rasio kemungkinan positif 7,5 dan rasio kemungkinan negatif 0,43.Kesimpulan. Kadar 25-hydroxyvitamin D mempunyai spesifisitas yang tinggi dan sensitivitas yang rendah sehingga dapat digunakansebagai penanda sepsis tambahan pada anak.
Perubahan Kadar Natrium dan Kalium Serum Akibat Pemberian Glukosa 40% pada Latihan Fisik Akut Wahyudi, Wahyudi; Ginting, Suryani; Siregar, Charles; Yoel, Chairul; Pasaribu, Syahril; Lubis, Munar
Sari Pediatri Vol 10, No 2 (2008)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp10.2.2008.77-82

Abstract

Latar belakang. Glukosa sumber energi untuk latihan fisik dan berpengaruh pada keseimbangan metabolisme tubuh. Glukosa menyebabkan masuknya ion natrium ke dalam sel. Sewaktu ATP terhidrolisis menjadi ADP, protein pembawa mengalami fosforilasi dan perubahan konformasi yang menyebabkan ion natrium dilepaskan ke cairan ekstrasel. Kemudian dua ion kalium berikatan di sisi ekstrasel masuk ke sel.Tujuan. Untuk mengetahui dan membandingkan perubahan kadar natrium dan kalium serum sebelum dan setelah latihan fisik akut pada kelompok yang diberikan air putih dan air berglukosa 40%.Metode. Empat puluh anak SLTP sehat yang dipilih secara acak sederhana mendapat minuman glukosa 40% (dosis 1 g/kgBB yang dilarutkan dalam 300cc air) (n=20) dan air putih sebanyak 300 cc (n=20). Semua anak diberi minum 10 menit sebelum latihan fisik, kemudian dilakukan latihan fisik selama 10 menit. Sampel darah vena diambil sebelum anak minum dan setelah melakukan latihan fisik.Hasil. Terjadi perubahan penurunan natrium serum berbeda bermakna setelah latihan fisik akut (p<0,05) pada kelompok air putih, sedangkan pada kelompok air berglukosa 40% terjadi peningkatan natrium serum. Perbandingan kadar natrium serum kedua kelompok berbeda bermakna (p<0,05). Kadar kalium serum tidak mengalami perubahan (p>0,05) pada kedua kelompok.Kesimpulan. �� � � � � � � ��� � � � � � -Pemberian minuman berglukosa 40% sebelum latihan fisik akut dapat menyebabkan peningkatan kadar natrium serum.
Gilles de La Tourette's Syndrome Yoel, Chairul; Siregar, A. Afif; Sutanto, A. H.
Paediatrica Indonesiana Vol 24 No 7-8 (1984): July - August 1984
Publisher : Indonesian Pediatric Society

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

Abstract

A case of Gilles de Ia Tourette's Syndrome is presented. This is the second reported case in Indonesia. The diagnosis was based on four essential features : childhood onset, multiple motor tics, vocal tics and changing pattern of the symptoms. The exact etiology of this syndrome is still unknown. It is proposed that patients with this illness could have hyperactivity of the dopaminergic systems in their basal ganglia. Symptomatic improvement has been achieved with haloperidol. The response to this drug could not be evaluated in this patient because of refusal to continue the treatment.
Comparison of SpO2/FiO2 and PaO2/FiO2 ratios as markers of acute lung injury Laila, Dewi Shandi; Yoel, Chairul; Hakimi, Hakimi; Lubis, Munar
Paediatrica Indonesiana Vol 57 No 1 (2017): January 2017
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (21.685 KB) | DOI: 10.14238/pi57.1.2017.30-4

Abstract

Background One of the diagnostic criteria for acute lung injury (ALI) is the PaO2/FiO2 (P/F) ratio. This measurement is obtained by blood gas analysis, which involves an invasive procedure (arterial blood draw). In order to reduce invasive procedures on critically ill patients, an alternative non-invasive marker for ALI is needed. The SpO2/FiO2 (S/F) ratio attained by pulse oximetry may be a suitable alternative.Objective To investigate for a correlation between S/F ratio and P/F ratio, in order to find an alternative non-invasive marker of ALI.Methods A cross-sectional study was conducted in the pediatric intensive care unit (PICU) at Haji Adam Malik Hospital, Medan from August 2012 to June 2013. Subjects (children aged 1 month – 18 years) underwent blood gas analysis when their pulse oximetry showed saturation of 80-97% within 24 hours of ventilator use. We measured PaO2, SpO2, and FiO2 and calculated S/F and P/F ratios. Data were analyzed by Spearman’s correlation and linear regression tests.Results Of 69 PICU patients, 39 children fulfilled the criteria for ALI. The S/F ratio and P/F ratio had a weak correlation (r=0.2; P=0.18). The linear regression equation was S/F ratio = 129.67 + 0.11 (P/F), with S/F ratio values of 162.67 and 151.67 correlating to P/F ratio values of 300 and 200, respectively.Conclusion  The S/F ratio has a weak correlation with P/F ratio for ALI in children.  
Hubungan Profil Lipid dan Derajat Keparahan Penyakit berdasarkan Skor Pediatric Logistic Organ Dysfunction-2 pada Anak dengan Sepsis Restiviona, Rince; Yoel, Chairul; Sianturi, Pertin
Sari Pediatri Vol 20, No 5 (2019)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (189.495 KB) | DOI: 10.14238/sp20.5.2019.289-94

Abstract

Latar belakang. Sepsis adalah penyebab kematian terbanyak pada bayi dan anak di rumah sakit. Sepsis dan syok septik menyebabkan perubahan neuroendokrin dan metabolik termasuk konsentrasi dan komposisi lipid plasma serta lipoprotein. Namun hubungan profil lipid dan derajat keparahan penyakit pada anak dengan sepsis masih belum jelas.Tujuan. Mengetahui cut-off profil lipid pada pasien anak dengan sepsis dan hubungan profil lipid terhadap derajat keparahan penyakit pada anak dengan sepsis.Metode. Penelitian potong-lintang bulan Juli sampai Oktober 2017 di PICU, RSUP Haji Adam Malik. Sampel adalah anak usia 1 bulan sampai <18 tahun yang didiagnosis sepsis. Pasien yang menderita diabetes melitus, sindrom nefrotik, gizi lebih, gizi buruk, mendapatkan terapi statin dan insulin diekslusikan. Didapatkan 30 orang anak yang memenuhi kriteria. Derajat keparahan penyakit dinilai berdasarkan skor PELOD-2. Nilai cut-off masing-masing profil lipid berdasarkan kurva ROC. Hubungan antara profil lipid dan derajat keparahan penyakit dianalisis dengan uji chi-square atau Fisher exact. Nilai p < 0,05 dianggap bermakna secara statistik .Hasil. Dari kurva ROC didapatkan nilai cut-off kadar kolesterol total dan trigliserida 93,5 mg/dL dan 199 mg/dL, dan nilai cut-off untuk kadar HDL dan LDL adalah 20,5 mg/dL dan 48,5 mg/dL. Didapatkan hubungan profil lipid dan derajat keparahan penyakit (PELOD-2) dengan nilai p: kolesterol total 0,007, trigliserida 0,005, HDL 0,063 dan LDL 0,279.Kesimpulan. Terdapat hubungan bermakna antara kadar kolesterol total dan trigliserida dengan derajat keparahan penyakit berdasarkan skor PELOD-2. Tidak terdapat hubungan bermakna antara HDL dan LDL dengan derajat keparahan penyakit berdasarkan skor PELOD-2.
Comparison of ventilation parameters and blood gas analysis in mechanically-ventilated children who received chest physiotherapy and suctioning vs. suctioning alone Elizabeth, Monalisa; Yoel, Chairul; Ali, Muhammad; Loebis, M. Sjabroeddin; Arifin, Hasanul; Sianturi, Pertin
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (867.979 KB) | DOI: 10.14238/pi56.5.2016.285-90

Abstract

Background Chest physiotherapy and suctioning are routine methods for airway clearance in mechanically-ventilated children. However, chest physiotherapy has not been confirmed to affect ventilation parameters, such as tidal volume (TV), peak inflation pressure (PIP), peak inspiratory flow (PIF), and peak expiratory flow (PEF), as well as blood gas analysis (BGA) values in pediatric intensive care unit (PICU) patients.Objective To determine the efficacy of chest physiotherapy and suctioning vs. suctioning alone for improving the mechanical ventilation parameters and BGA.Methods This randomized, single-blind, clinical trial was conducted from November 2012 to June 2013 in the PICU at Haji Adam Malik Hospital, Medan. A total of 40 mechanically-ventilated pediatric patients were enrolled and divided into either the chest physiotherapy and suctioning group (24 subjects) or the suctioning alone group (16 subjects). Subjects underwent treatment, followed by monitoring of their ventilation parameters and blood gas analyses. Data were analyzed by independent t-test and Mann-Whitney test.Results Subjects comprised of 23 boys and 17 girls, with an age range of 1–204 months. After the respective treatments (chest physiotherapy and suctioning vs. suctioning alone), the ventilation parameters were as follows: median TV (60.0 vs. 56.5 mL, respectively; P=0.838), median PEF (10.4 vs. 10.8 I/s, respectively; P=0.838), median PIF (7.4 vs. 8.2 I/s, respectively; P=0.469), and mean PIP (17.3 vs. 15.6 cmH2O, respectively; P=0.23). The BGA values were: median pH (7.4 vs. 7.3, respectively; P=0.838), median pCO2 (38.4 vs. 36.2 mmHg, respectively; P=1.000), mean pO2 (136.6 vs. 139.2 mmHg, respectively; P=0.834), median HCO3 (20.4 vs. 22.7 mmol/L, respectively; P=0.594), median TCO2 (22.0 vs. 23.7 mmol/L, respectively; P=0.672), mean BE (-4.3 vs. -3.1 mmol/L, respectively; P=0.629), and median O2 saturation  (98.5 vs. 98.3 %, respectively; P=0.967).Conclusion In mechanically-ventilated children in the PICU, ventilation parameters and BGA values are not significantly different between subjects who received both chest physiotherapy and suctioning and those who received suctioning alone.
Association between Acid-Base Balance and Asphyxia in Newborn Infants Harahap, Sari Leyli; Harahap, Chairul Adillah; Sulastri, Sri; Yoel, Chairul; Raid, Noersida
Paediatrica Indonesiana Vol 34 No 1-2 (1994): January - February 1994
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (421.241 KB) | DOI: 10.14238/pi34.1-2.1994.38-43

Abstract

We performed a prospective study on the association between acid-base balance and asphyxta based on Apgar scores in 45 newborn babies admitted to the Division of Perinatology, Pirngadi Hospital, Medan, from January 1 to February 28, 1993. Blood gas analysis was done on blood obtained from umbilical artery. Based on 1st and 5th minutes Apgar scores, 40 (88.9%) and 21 babies (46.7%}, respectively, had asphyxia. Relation to acid-base balance was determined with the sensitivity of the 5th minute Apgar score in predicting acidotic states. It was found that Apgar score had sensitivity of 57.7% and specificity of 68.4% in predicting the acidotic states. Apgar score of > 7 was unable to. exclude the possible acidosis in 45% of cases (negative predictive value 54.1%). Gestational age had no influence on Apgar Scores. Apgar score was more sensitive to eliminate suspected acidosis in term neonates than in preterms. We recommend to perform umbilical arterial blood gas analysis to determine acidotic state in high risk newborn infants.
Treatment of Neonatal Tetanus with High Dosage Diazepam Dharmawati, Tjut; Rizal, Fauzi; Lubis, Munar; Yoel, Chairul; Pasaribu, Syahril; Lubis, Chairuddin P.
Paediatrica Indonesiana Vol 33 No 3-4 (1993): March - April 1993
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (615.71 KB) | DOI: 10.14238/pi33.3-4.1993.71-6

Abstract

A retrospective study on neonatal tetanus, among patients hospitalized at the pediatric ward of Dr. Pirngadi Hospital Medan, bad been conducted from january 1987 through December 1991. There were 75 cases out of 13,581 patients hospitalized (0.55%) in that period, consisting of 44 boys (58.66%) and31 girls (47 3 %) with an overall case fatality rate of 33.33%. Of 18 patients with an incubation period of 5 days or less, 12 (66.66%) died, while of 4 patients with an incubation period of more than 10 days, there were not any death at all. Diazepam had been given in a dosage of 10-40 mg/kg body weight/day . Diazepam of 10-19 mg/kg body weight/day was given to 4 cases, and the case fatality rate was 25% . Of 42 cases treated with diazepam of 30-40 mg/kg body weight/day, the case fatality rate was 42.85% The duration of hospitalization varied between ten hours to 34 days. All deaths (25 cases) occurred within the first seven days of hospitaltization. The most common accompanying disease was bronchopneumonia (6 cases). Endotracheal intubation were performed on 11 cases, while the mechanical ventilator in 1 case with a case fataliy rate of 27,27% and 0% respectively.
Luka Tembak Tembus Kepala pada Remaja Laki-laki Lestari, Indah Nur; Yoel, Chairul; Lubis, Munar; Saragih, Rina Amalia; Yanni, Gema Nazri
Cermin Dunia Kedokteran Vol 47, No 2 (2020): Penyakit Infeksi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (269.565 KB) | DOI: 10.55175/cdk.v47i2.355

Abstract

Luka tembak tembus kepala adalah luka otak disebabkan trauma fisik berupa penetrasi massa tajam yang menembus tengkorak dan jaringan otak. Luka tembak tembus memiliki luka masuk dan luka keluar. Dilaporkan kasus luka tembak tembus kepala. Penetrating gunshot wound was caused by projectiles. Peneterating gunshot have an entrance wounds and exit wounds. This is a case report of cranial penetrating gunshot wounds.
Hubungan 25-hydroxyvitamin D Dengan Sepsis Pada Anak Tjowanta, Austin Simon; Yoel, Chairul
Cermin Dunia Kedokteran Vol 45, No 6 (2018): Penyakit Dalam
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1069.082 KB) | DOI: 10.55175/cdk.v45i6.660

Abstract

Sepsis masih merupakan penyebab utama morbiditas dan mortalitas pada anak. Bukti terbaru menunjukkan bahwa vitamin D dapat meningkatkan respons imun bawaan dengan menginduksi peptida antimikroba. Pada anak sepsis dijumpai penurunan kadar 25-hydroxyvitamin D dan risiko sepsis meningkat pada pasien kekurangan vitamin D. Risiko mortalitas lebih tinggi pada pasien sepsis yang kekurangan vitamin D. Pemberian vitamin D pada anak dapat mengurangi keparahan penyakit dan juga menurunkan mortalitas.Sepsis is a major cause of morbidity and mortality in pediatric population, despite scientific progresses in the last decades. Recent evidences suggest that vitamin D may enhance the innate immune response by induction of antimicrobial peptides. Children with sepsis have decreased 25-hydroxyvitamin D levels and vitamin D deficiency patients have increased sepsis risk. Vitamin D-deficient sepsis patients have higher risk of mortality compared to sepsis patients with normal vitamin D levels. Vitamin D supplementation may decrease the severity of illness and also reduce mortality.
Co-Authors A. H. Sutanto, A. H. Chairuddin P. Lubis Charles Siregar, Charles Dewi Shandi Laila, Dewi Shandi Dharmawati, Tjut Elizabeth, Monalisa Hakimi Hakimi Harahap, Chairul Adillah Harahap, Sari Leyli Hasanul Arifin Lestari, Indah Nur Loebis, M. Sjabroeddin MUHAMMAD ALI Munar Lubis, Munar Noersida Raid, Noersida Pertin Sianturi Restiviona, Rince Saragih, Rina Amalia Siregar, A. Afif Sri Sulastri Suryani Ginting Syahril Pasaribu, Syahril Tjowanta, Austin Simon Tjowanta, Austin Simon Wahyudi Wahyudi Yanni, Gema Nazri