Correlation of Troponin Level (Troponin T, Troponin I) With PELOD-2 Score in Sepsis as a Predictive Factor of Mortality

BACKGROUND: Sepsis in children with cardiovascular involvement can increase mortality. Recently, many studies have been conducted to investigate troponin as an early marker of myocardial dysfunction, associated with pediatric sepsis score. Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score is recent scoring to assess organ dysfunction in sepsis children. AIM: To determine the correlation between troponin T, troponin I with PELOD-2 score in sepsis as a predictive factor of mortality. METHODS: A prospective cohort study was conducted on sepsis children in PICU Haji Adam Malik General Hospital, Medan. Assessment of PELOD-2 score, serum troponin T, and troponin I levels performed on the first day and 48 hours after sepsis was diagnosed. Patients were observed until moved to the ward or died. RESULTS: A group of 41 subjects were recruited in this study. Troponin T level at 24 hours did not correlate with PELOD-2 scores. Troponin T level at 48 hours was positively correlated with PELOD-2 score (r = 0.771, p < 0.001) and had a significant association with the mortality rate (p < 0.001). Troponin T at 48 hours could be used as a predictive factor of mortality (AUC 86.4%, p < 0.001) with a cut-off point of 40.3 ng/mL (76% sensitivity, 75% specificity, RR 2.48). Troponin I levels at 24 and 48 hours also had strong correlation with PELOD-2 score (r = 0.326, p = 0.037; r = 0.691, p < 0.001) and could be used as a predictor of mortality in pediatric patients with sepsis (AUC 74.8%, p 0.008; AUC 92.6%, p < 0.001). The cut-off point of troponin I at 24 hours was 0.075 ng/mL (68% sensitivity, 68.8% specificity, RR 1.84) and at 48 hours was 0.125 ng/mL (80% sensitivity, 81.3% specificity, RR 3.13). CONCLUSION: Serum troponin T and troponin I levels at 48 hours have positive correlation with PELOD-2 score as a predictive factor of mortality in pediatric patients with sepsis

The Influence of Albumin Level in Critically Ill Children to Length of Stay and Mortality in Paediatric Intensive Care Unit

BACKGROUND: The use of albumin in the critical care setting is a very controversial issue. Low serum albumin concentration in critical illness is associated with a poor outcome. AIM: We aimed to evaluate the influence of albumin level in critically ill children to the length of stay and mortality in the Pediatric Intensive Care Unit (PICU) Haji Adam Malik General Hospital, Medan, Indonesia. METHODS: The study used an observational method with a cross-sectional design. The population of the study was all patients with major postoperative surgery and critically ill that admitted to the PICU at Haji Adam Malik Hospital from the period of June 2008 to September 2008. The albumin level of the subjects was determined on the first day admitted. RESULTS: The group with hypoalbuminemia (< 3 g/dL) was given albumin supplementation according to a protocol in the PICU. The group with hypoalbuminemia have an average length of stay 7.6 days (9.7%) and mortality of 12 subjects (36.4%). The group with normal albumin level have 4.7 days (5.0%) and mortality 13 subjects (37.1%). There was no significant effect of albumin level to mortality. CONCLUSION: Albumin level did not affect the length of stay and mortality in PICU

Contribution of Plasmodium knowlesi to Multispecies Human Malaria Infections in North Sumatera, Indonesia.

Background: As Indonesia works toward the goal of malaria elimination, information is lacking on malaria epidemiology from some western provinces. As a basis for studies of antimalarial efficacy, we set out to survey parasite carriage in 3 communities in North Sumatera Province. Methods: A combination of active and passive detection of infection was carried out among communities in Batubara, Langkat, and South Nias regencies. Finger-prick blood samples from consenting individuals of all ages provided blood films for microscopic examination and blood spots on filter paper. Plasmodium species were identified using nested polymerase chain reaction (PCR) of ribosomal RNA genes and a novel assay that amplifies a conserved sequence specific for the sicavar gene family of Plasmodium knowlesi. Results: Of 3731 participants, 614 (16.5%) were positive for malaria parasites by microscopy. PCR detected parasite DNA in samples from 1169 individuals (31.3%). In total, 377 participants (11.8%) harbored P. knowlesi. Also present were Plasmodium vivax (14.3%), Plasmodium falciparum (10.5%) and Plasmodium malariae (3.4%). Conclusions: Amplification of sicavar is a specific and sensitive test for the presence of P. knowlesi DNA in humans. Subpatent and asymptomatic multispecies parasitemia is relatively common in North Sumatera, so PCR-based surveillance is required to support control and elimination activities

Recurrence of Plasmodium malariae and P. falciparum Following Treatment of Uncomplicated Malaria in North Sumatera With Dihydroartemisinin-Piperaquine or Artemether-Lumefantrine.

BACKGROUND: We assessed the efficacy of artemisinin-based combination therapies for treatment of uncomplicated falciparum malaria, with or without co-infecting Plasmodium spp., in Sumatera, Indonesia. METHODS: Febrile patients aged >6 months with uncomplicated P. falciparum were randomized to receive dihydroartemisinin-piperaquine or artemether-lumefantrine, plus single-dose primaquine, and were followed for 42 days. Mixed Plasmodium infections were included; P. vivax infections received 14 days of primaquine. We retrospectively restricted the analysis to cases with polymerase chain reaction (PCR)-confirmed parasitemia. Recurrent parasitemia in follow-up was identified by species-specific nested PCR. RESULTS: Of the 3731 participants screened, 302 were enrolled and randomized. In the dihydroartemisinin-piperaquine arm, P. falciparum infections were confirmed by PCR in 59 participants, with mixed infections in 23 (39.0%). In the artemether-lumefantrine arm, P. falciparum infections were confirmed by PCR in 55 participants, with mixed infections in 16 (29.0%). Both regimens were well tolerated, and symptoms improved rapidly in all treated participants. In the dihydroartemisinin-piperaquine arm, 1 P. falciparum recurrence (on day 7) and 6 P. malariae recurrences (1 had a mixed infection with P. falciparum) were identified during days 3-42 of follow-up. In the artemether-lumefantrine arm, 1 P. falciparum/P. malariae/P. vivax recurrence occurred on day 35. Submicroscopic persistence occurred during follow-up in 21 (37%) of 57 receiving dihydroartemisinin-piperaquine and 20 (39%) of 51 receiving artemether-lumefantrine. CONCLUSIONS: In Sumatera, both regimens effectively cleared initial parasitemia, but P. falciparum and P. malariae persisted in some individuals. Molecular species detection should be deployed in antimalarial efficacy trials in Indonesia. TRIAL REGISTRATION: NCT02325180

Effectiveness of Vitamin A in Albendazole Against Reinfection of Ascaris Lumbricoides

WHO recommends the supplementation of 200,000 IU vitamin A into 400 mg albendazole to cut down its reinfection. A Randomized Controlled Trial was conducted in SD N 384  Sikapas, North Sumatera from April - June 2016. Inclusion criteria were children with ascariasis. Sample divided into intervention and control group. Kato-Katz was used to identify egg worms and faecal egg count intensity (FECs). P value < 0.05 was consider significant. After three months follow up, there were 51 and 56 samples in intervention and control group with average age 9.6 years (SD 1.99) and 9.7 years (SD 2.20). Prevalence of ascariasis was 75.5%. There was no significant difference in Ascaris lumbricoides reinfection but instead of in FECs intensity. The NNT was 22.31. The addition of vitamin A in albendazole was not suggested according to this study

The Association between the Level of Antithrombin III and Mortality in Children with Sepsis

BACKGROUND: Sepsis is a significant cause of morbidity and mortality in children. The diagnosis of sepsis remains continuing to develop which determines treatment and prognostic. Antithrombin III is one of the coagulation markers to evaluate the prognosis of sepsis. AIM: To determine the association between the level of antithrombin III and mortality in children with sepsis in the Pediatric Intensive Care Unit, Haji Adam Malik General Hospital, Medan. METHODS: A cross-sectional study was conducted in Haji Adam Malik General Hospital, Medan from April until June 2015. There were 41 children with sepsis. Sepsis was diagnosed from clinical and laboratory findings. Complete blood count, antithrombin III level, C-reactive protein and procalcitonin were an indicator of unproven sepsis that performed in the laboratory. Meanwhile blood culture was performed in the microbiology laboratory. The association between the level of antithrombin III and mortality was analysed by using chi-square test. RESULTS: Of the 41 participants, the low antithrombin III level was 13 of 41 children (31.7%) meanwhile the normal antithrombin III level was 28 of 41 children (68.3%). There was 8 of 13 (42.1%) and 11 of 28 (57.9%) children in death cases of low and normal antithrombin III level, respectively. Samples with low antithrombin III level had 2.473 higher risk mortality than normal antithrombin III level (P = 0.184; 95% CI 0.641 to 9.5421; PR = 2.473). CONCLUSION: There was no statistically significant association between levels of antithrombin III and mortality in children with sepsis

Paparan Suara yang Diperlakukan pada Tanah dan Air terhadap Populasi Mikroba dan P Tersedia Tanah

Suara sebagai faktor lingkungan dapat mempengaruhi kehidupan di alam, baik makro maupun mikro, berbagai suara juga dapat mempengaruhi bentuk kristal air, seperti penelitian seorang ilmuwan dari Jepang Prof. Dr. Masaru Emoto terhadap air. Diketahui bahwa komponen ideal tanah mineral diantaranya terdiri dari 25% air dan 5% kandungan bahan organik, yang kehidupan tanah ada di dalamnya. Penelitian ini bertujuan untuk membandingkan populasi total mikroba dan P tersedia dalam tanah yang diperdengarkan suara dan diberi air yang diperlakukan suara. Penelitian ini dilaksanakan di laboratorium ilmu tanah Fakultas Pertanian Universitas Muhammadiyah Sumatera Utara pada bulan Agustus sampai Oktober 2018. Rancangan yang digunakan adalah Rancangan Petak Terpisah dengan 3 ulangan. Petak utama adalah suara murotal (S) dengan 2 taraf, yaitu S0 = tanpa suara murotal dan S1 = dengan suara murotal.  Anak petak adalah air yang diperlakukan, terdiri dari A0 = Air tanpa diperdengarkan suara, A1 = Air yang diperdengarkan suara murotal, A2 = Air yang diperdengarkan suara kasar.  Parameter yang diukur adalah populasi total mikroba tanah dan kandungan P tersedia tanah. Hasil penelitian menunjukkan bahwa paparan suara secara utuh dapat meningkatkan P tersedia tanah secara signifikan dari 77,1 ppm menjadi 86,7 ppm (11,07%)

Video Design for Clean and Honest Characters Strengthening of Mahasantri Ma'had Al-Jamiah IAIN Padangsidimpuan

Character Education is an important element in developing affective to be good person especially as mahasantri, and it is significant to create the good value of clean and honest. The study aims to design video of ‘clean and honest living characters’ among mahasantri in Ma’had Al-Jami’ah IAIN Padangsidimpuan. Designing video for ‘clean and honest living character’ is resulted by research and development. This study use Focus Group Discussion as the instrument, beside observation and interview. Based on the instrument, it is found that content of video was designed into two videos of ‘clean character’ and ‘honest character’. These two videos contains of four parts: part 1 is monolog about clean and health life character, part 2 is the slogan of clean and health living character, part 3 is the picture that show the contrast of positive and negative condition, and part 4 is short story about clean and health life character. Keywords: Video design; character education; living characters

Plasmodium falciparum Isolates Carrying pfk13 Polymorphisms Harbor the SVMNT Allele of pfcrt in Northwestern Indonesia.

Artemisinin-based combination therapy (ACT) is the first-line antimalarial regimen in Indonesia. Susceptibility of Plasmodium falciparum to artemisinin is falling in the Greater Mekong subregion, but it is not known whether the efficacy of current combinations is also threatened in nearby Sumatera. We evaluated the genetic loci pfcrt, pfmdr1, and pfk13, considered to be under selection by artemisinin combination therapy, among 404 P. falciparum infections identified by PCR detection in a cross-sectional survey of 3,731 residents of three regencies. The pfcrt haplotype SVMNT (codons 72 to 76) was the most prevalent and displayed significant linkage disequilibrium with the pfmdr1 haplotype YY (codons 86 and 184) (odds ratio [OR] 26.7; 95% confidence interval [CI], 5.96 to 239.4; P < 0.001). This contrasts with Mekong countries, where the CVIET haplotype of pfcrt predominates. Among 231 evaluable isolates, only 9 (3.9%) showed any evidence of nonsynonymous gene variants in the propeller domain of pfk13 The Thr474Ala variant was seen in six individuals, and Cys580Tyr was identified with low confidence in only a single isolate from an asymptomatic individual. Among a subset of 117 symptomatic P. falciparum-infected individuals randomized to receive either dihydroartemisinin-piperaquine or artemether-lumefantrine, the treatment outcome was not associated with pretreatment genotype. However, submicroscopic persistent parasites at day 28 or day 42 of follow-up were significantly more likely to harbor the pfmdr1 haplotype NF (codons 86 and 184) than were pretreatment isolates (P < 0.001 for both treatment groups). Current ACT regimens appear to be effective in Sumatera, but evidence of persistent submicroscopic infection in some patients suggests further detailed studies of drug susceptibility should be undertaken