Ari L. Runtunuwu

Hubungan Kadar Serum Metabolit Nitrit Oksida dan Gangguan Fungsi Ginjal pada Sepsis

Latar belakang. Sepsis adalah respons sistemik terhadap infeksi dengan salah satu komplikasinya berupa gagal organ ginjal. Peran nitrit oksida (NO) sebagai mediator yang terlibat dalam mekanisme gagal organ ginjal kasus sepsis masih bersifat kontroversi. Tujuan . Mengevaluasi hubungan antara kadar serum NO dan gangguan fungsi ginjal pada sepsis anak. Metode. Desain penelitian potong lintang secara konsekutif dilaksanakan sejak bulan Juni sampai November 2012 dengan sampel anak usia satu bulan sampai lima tahun yang didiagnosis sepsis. Pemeriksaan kadar serum kreatinin mencerminkan fungsi ginjal dan kadar serum metabolit NO (nitrat dan nitrit) mencerminkan kadar NO endogen. Uji korelasi menggunakan uji korelasi Spearman, dinyatakan bermakna apabila p<0,05. Data diolah menggunakan piranti lunak SPSS 19.00 Hasil . Diperoleh 40 subjek dengan median usia 8,5 bulan (2 sampai 70 bulan) dan 22 di antaranya anak laki-laki. Kadar metabolit NO ditemukan berhubungan dengan kadar serum kreatinin (rs=0,33; p=0,041). Kesimpulan. Terdapat hubungan antara peningkatan kadar serum NO dan terjadinya gangguan fungsi ginjal pada anak dengan sepsis.

Faktor Risiko Kejadian Distres Pernapasan pada Anak dengan Pneumonia

Latar belakang. Distres pernapasan pada pneumonia merupakan kegawatan medis pada anak yang sering terjadi akibat berbagai faktor. Tujuan. Mengetahui faktor-faktor risiko yang berhubungan dengan kejadian distres pernapasan pada anak dengan pneumonia. Metode. Desain penelitian analitik observasional, cross sectional. Subjek penelitian adalah semua anak pneumonia berusia 2-24 bulan yang dirawat di Bagian Ilmu Kesehatan Anak RSU Prof. Dr. R.D.Kandou Manado Juni - Nopember 2005. Subjek dibagi menjadi kelompok pneumonia dengan dan tanpa distres pernapasan. Hasil. Dari 68 kasus pneumonia, didapatkan 35 (51,5%) disertai distres pernapasan dan 33 (48,5%) tanpa distres pernapasan. Lama pendidikan ayah, lama pendidikan ibu, jumlah leukosit saat masuk rumah sakit, lama sakit di rumah, keluarga perokok dan hasil biakan darah mempengaruhi terjadinya distres pernapasan pada anak dengan pneumonia. Kesimpulan. Lama pendidikan ayah, lama pendidikan ibu, jumlah leukosit, lama sakit di rumah dan keluarga perokok mempengaruhi terjadinya distres pernapasan pada anak dengan pneumonia. Secara bersama-sama faktor lama sakit di rumah, keluarga perokok dan hasil biakan mempunyai hubungan dengan kejadian distres pernapasan pada anak dengan pneumonia

Effect of intravenous gentamicin on urinary calcium excretion in newborns

Background Studies in newborns and animals have shown that gentamicin increases urinary calcium excretion. New recommendation for gentamicin in newborns is administered intravenously 36-48 hourly. Subsequent to this new recommendation, there have been no further studies on the effects of extended gentamicin dosage on urinary calcium excretion in newborns. Objective To assess the effect of intravenous gentamicin on urinary calcium excretion in newborns. Methods This pretest – posttest study was done in the Neonatology Division of Prof. DR. R. D. Kandou Hospital, Manado, from August to November 2013 . Subjects were full-term newborns who received intravenous gentamicin every 36 hours and whose parents provided informed consent. We excluded newborns with asphyxia and cardiovascular shock, also those who received diuretics or steroids. Urine spot collection was done before, after the first dose, and after the second dose of intravenous gentamicin. Urinary calcium and creatinine levels were measuerd. Urine calcium excretion was defined as the ratio of urinary calcium to creatinine level. Results Of 28 newborns, there were 16 males and 12 females. The median of urine calcium creatinine ratio before intravenous gentamicin was 0.021 (range 0.004 to 0.071) mg/mg. After first dose of gentamicin, the median ratio was 0.043 (range 0.009 to 0.156) mg/mg, and after the second dose of gentamicin, the median ratio was 0.144 (range 0.015 to 1.160) mg/mg. Conclusion There is a significant increase in urinary calcium excretion after the first and second doses of intravenous gentamicin. Furthermore, a cumulative effect of gentamicin on urinary calcium excretion is observed after the second dose.

Comparison of blood plasma and gelatin solution in resuscitation of children with dengue shock syndrome

Background Dengue shock syndrome (DSS) is characterized by severe vascular leakage and hemostasis disorder. It is the cause of death in 1 to 5 percent of cases. WH 0 management guidelines for resuscitation remain empirical rather than evidence-based. Objective To find out the alternative fluids to replace plasma leakage in DSS. Methods We performed a prospective study and randomized comparison of plasma and gelatin solution for resuscitation of Indonesian children with DSS. We randomly assigned 25 subjects with DSS to receive plasma and 25 children to receive gelatin fluid. Statistical analyse were performed using chi-square test, Fishers exact test, t test, Mann-Whitney test. Results The increment of pulse pressure width and the decrement of hematocrit in subjects treated with gelatin were higher than that of plasma atfour-hour therapy (P=0.002 and P=0.017). Only one patient died caused by unusually manifestation of DSS. The increment of body temperature in subjects treated with plasma was higher than that of gelatin at four-hour therapy (P=O.Oll). The decrement of platelet count in subjects treated with gelatin were less than that of plasma (P=0.018). The increment of diuresis rate in subjects treated with gelatin was higher than that of plasma at twenty-hour therapy (P 0.05). Conclusions Gelatin solution can be used as volume replacement in resuscitation of DSS if blood plasma is not available especially at four-hour therapy.