RISK FACTORS OF CONGENITAL ANOMALIE AT HAJJ ADAM MALIK GENERAL HOSPITAL AND UNIVERSITY OF NORTH SUMATERA HOSPITAL IN 2017-2019.

Background. Congenital abnormalities or congenital abnormalities are abnormalities that have existed since birth that can be caused by genetic and non genetic factors. The study of congenital abnormalities is called dysmorphology. Congenital abnormalities are one of the biggest contributors to death and morbidity in neonates, infants, and children. There were 7.9 million cases of congenital abnormalities and 3.3 million premature deaths due to congenital abnormalities in the world in 2013. In Southeast Asia it is estimated that cases of congenital abnormalities numbered 1,946,606 cases each year in 2013 according to WHO. In 2018, more than 8 million babies worldwide are born every year with congenital abnormalities. In the United States nearly 120,000 babies are born with congenital abnormalities each year. The cause of fetal congenital abnormalities due to genetic and non-genetic factors. Single gene mutations, balance disorders due to chromosomal abnormalities, and multifactorial abnormalities are included in genetic factors. Non-genetic factors can be caused by teratogen drugs (drugs, chemicals, infections, and maternal diseases that affect the fetus) and radiation. There are 5 risk factors that influence the occurrence of fetal congenital abnormalities, namely genetic, socioeconomic and demographic factors, environment, infection, and nutritional status. Aim. To determine the risk factors for congenital abnormalities in newborns at the Haji Adam Malik General Hospital and the University Hospital of North Sumatra in 2017-2019. Method. The design used by researchers uses a cross-sectional approach. The sample used was Patients with Congenital Abnormalities who were in the Human Rights Hospital and USU Hospital in 2017-2019. Result. The most influential risk factors for fetal abnormalities are maternal age, disease history, infectious history, and poor nutritional status. There are no results that can prove that the history of pregnancy affects the occurrence of fetal congenital abnormalities

Platelet Profile as Prognostic Factor in Critically ill Children

BACKGROUND: Previous studies showed that platelet profile may reflect the platelet function better than the platelet count itself, but the study on its use as a prognostic indicator in critically ill children is still limited. AIM: We analyzed the association between platelet profile such as platelet count, plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) and mortality, also its correlation with pediatric logistic organ dysfunction-2 (PELOD-2) score in critically ill children admitted to the pediatric intensive care unit (PICU). METHODS: A prospective cohort study was conducted in PICU Haji Adam Malik General Hospital, Medan. Assessment of platelet profile (platelet count, PCT, MPV, and PDW) and PELOD score on the 1st and 3rd day of PICU admission were performed. RESULTS: Eighty-three subjects were recruited in this study, 44 were boy with a median age of 6 (1–17) years old. The septic patient was 43 subjects (51.8%). Platelet count on the 1st day (p = 0.024) and PDW on the 3rd day (p = 0.018) of PICU admission was significantly associated with mortality. There was no correlation between platelet profile and PELOD-2 score on day 1 and 3. However, the difference between MPV on days 1 and 3 (ΔMPV) significantly correlated with the change of PELOD-2 score (r = 0,647, p < 0.0001). CONCLUSION: Platelet count on 1st day and PDW on the 3rd day had a significant association with mortality but no correlation between platelet profile and PELOD-2 score

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

Thyroid Hormone Profile in Children with Sepsis: Does Euthyroid Sick Syndrome Exist?

BACKGROUND: Alterations in peripheral thyroid hormone metabolism play an eminent role in the development of the euthyroid sick syndrome. Altered solvation may also lead to changes in peripheral thyroid hormones. Data on thyroid hormones in critically ill children remain unclear. AIM: This study was aimed to evaluate thyroid hormone profile in children with sepsis as well as to assess the association between thyroid level and sepsis outcome. METHODS: An observational cohort study was conducted in 80 children with sepsis from October 2015 to January 2016 in Haji Adam Malik General Hospital. T3 and T4 level were measured on day 1 and after > 72 hours of sepsis diagnosed. RESULTS: We recorded length of stay in PICU, patient outcome and analysed the relationship with the chi-square test. Level of T3 and T4 were decreased on day 1 in pediatric sepsis. Of 80 subjects, 57 (71.2%) with low-level T3 and 41 (51.2%) with low T4 were found. The relationship between T3 and T4 level on day 1 with the length of stay were not found (P = 0.500; P = 0.987). There were a significant relationship between level of T3 and T4 with outcome (P = 0.0001; OR 24.706; P = 0.014; OR 3.086). Subject with normal T3 and T4 level had 24 and 3 times life chances compare to lower level. CONCLUSION: The Euthyroid Sick Syndrome in children with sepsis does exist. There was a significant relationship between T3 and T4 level on day 1 with patient outcome

Improved basic life support skills and patient transportation at ambulance drivers in Medan Tuntung and Medan Sunggal area to improve patient safety

The technique of providing basic and quick life support (BHD) and transportation to patients with cardiac and pulmonary arrest can save a patient's life. An ambulance driver as one of the ambulance personnel should be equipped with the two forms of skills above. The aim of community service is to increase the capacity of ambulance drivers in terms of providing basic life support skills and patient transportation to improve patient safety. This training was held in September 2019, at the H. Adam Malik General Hospital Training Center Installation Medan, with 24 participants. The training is carried out with 2 methods, namely exposure to BHD theory and BHD skills training. The knowledge and skills of participants before and after the training were assessed. Pre and post assessment results were analyzed using paired t-test with a significance level of p <0.05 Ambulance drivers in the Medan Tuntung and Medan Sunggal area are mostly over 30 years old, with most working as ambulance drivers for more than 5 years. The most recent level of education is high school graduation or equivalent. The results of statistical analysis using paired t-test, obtained a significant difference in the knowledge of ambulance drivers about basic life support theory before and after training (p = 0.000). Likewise, ambulance driver skills in providing basic life support for adult patients, infants and children were significantly different before and after training (p = 0.000). Training in basic life support skills and patient transportation can increase the capacity of ambulance drivers in providing basic life support.

Correlation of Hepatocyte Growth Factor Levels with Myopia Degree and Axial Length in Outpatient Myopic Adolescents

Myopia is the most common ophthalmic condition worldwide, with an estimated 22.9% of the population or 1.406 billion people affected. Studies of candidate gene-associated refraction abnormalities have also identified several genes that cause vulnerability myopia, including the hepatocyte growth factor (HGF) and  hepatocyte growth factor receptor (MET) genes. The purpose of the study was to analyze the correlation between hepatocyte growth factor (HGF) levels, degrees of myopia, and long axial in adolescents with myopia treated as outpatients in Universitas Sumatera Utara Hospital. This study applied the cross-sectional analytical approach. The inclusion criterion for the participants was patients diagnosed as suffering from myopia by the Ophthalmology Outpatient Clinic of the Universitas Sumatera Utara Hospital. Sampling was performed consecutively with a minimum sample size of 25 patients in control group and 25 patients in the case group. This study revealed that the mean axial length of the right eye in the case group was 23.82 mm, with a significant difference in the axial length between the case and control groups. The mean HGF level in the myopia group was 510.49 ng/mL, which was not significantly different from the mean HGF level in the control or emmetropic group. The HGF levels were highest in the group of subjects with moderate myopia, with an average of 551.87 ng/mL, and differences in HGF levels were identified in different degrees of myopia. Thus, no significant correlation is identified between the HGF levels, axial length, and myopia degree

Triiodothyronine levels and mortality in children with sepsis and septic shock

Background Sepsis is the most common cause of death in infants and children. It can cause hormonal imbalances, such as euthyroid sick syndrome (ESS), which may increase the risk of death. Objective To evaluate a possible correlation between the level of triiodothyronine (T3) and mortality in children with sepsis and septic shock. Methods An observational cohort study was conducted on 80 children with sepsis and septic shock from October 2015 until January 2016 in Haji Adam Malik General Hospital, Medan. Subjects underwent PELOD score and T3 examination on the first day admitted in Haji Adam Malik General Hospital. Chi-square test was used to analyze for a correlation between the T3 values and mortality.  Results Of the 80 consecutive subjects, 39 (48.75%) had low T3 level on the first day. Of these 39 children, 36 (92.3%) died. Subjects with low T3 level had a 6.31 times higher risk of mortality(PR 6.31;  95%CI 2.99 to 13.28; P<0.001). Of the 31 subjects with high PELOD score, 23 (74.2%) had decreased T3 (PR=2.27; 95%CI 1.45 to 3.57; P<0.001). Conclusion Low T3 level has significant relationship with mortality in children with sepsis and septic shock

Red cell distribution width and mortality in pediatric sepsis

Background Red cell distribution width (RDW) is a hematological parameter routinely obtained as part of the complete blood count. Recently, RDW has emerged as a potential independent predictor of clinical outcomes in adults with sepsis. However, RDW as a mortality predictor in pediatric populations has not been well established. Objective To determine the relationship between RDW value and mortality outcomes in pediatric sepsis patients. Methods We performed a cross-sectional study of 40 consecutive pediatric patients with sepsis admitted to the PICU from December 2013 to March 2014. All patients’ RDW were collected within 24 hours of sepsis diagnosis. We determined the association between RDW and hemoglobin (Hb) using Spearman’s correlation. The RDW values of 11.5-14.5% were considered to be normal while those > 14.5% were considered to be elevated. We compared mortality and PICU length of stay (LoS) between the normal and elevated RDW groups using Chi-square and Mann-Whitney tests. Results The median age of patients was 34 months (range 2 months to 17 years). There were 28 (70%) male subjects. Subjects’ median RDW was 14.8% (range 11.2-27.8%) and was not correlated with Hb (r=0.056; P=0.73). Mortality rates in the normal and elevated RDW groups were 40% and 45%, respectively. There were no significant associations between RDW group and mortality (P=0.749) or PICU LoS (P=0.350). Conclusion Unlike in adults, RDW values are not correlated with mortality in pediatric sepsis patients