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Mulyadi M. Djer
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis Nusarintowati Ramadhina; Rubiana Sukardi; Najib Advani; Rinawati Rohsiswatmo; Sukman T. Putra; Mulyadi M. Djer
Paediatrica Indonesiana Vol 55 No 4 (2015): July 2015
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (126.089 KB) | DOI: 10.14238/pi55.4.2015.203-8

Abstract

Background Hemodynamic instability in sepsis, especially in the neonatal population, is one of the leading causes of death in hospitalized infants. The major contribution for heart dysfunction in neonatal sepsis is the myocardial dysfunction that leads to decreasing of ventricular function. The combination of echocardiography and laboratory findings help us to understand the ventricular condition in preterm infants with sepsis.Objective To assess for a correlation between ventricular function and serum high-sensitivity cardiac troponin T (hs-cTnT) level in preterm infants with neonatal sepsis.Methods We prospectively studied 30 preterm infants with neonatal sepsis who were admitted to the neonatal intensive care unit (NICU) of Cipto Mangunkusumo Hospital from June 1 – August 31, 2013. The ventricular functions were measured using 2-dimensional echocardiography. The parameters of right ventricular (RV) function assessment were tricuspid annular plane systolic excursion (TAPSE) and RV myocardial performance index (MPI). For left ventricular (LV) performance, we assessed ejection fraction (EF), fractional shortening (FS), and LV-MPI. Serum hs-cTnT was measured and considered to be a marker of myocardial injury.Results Subjects had a mean gestational age of 31.5 (SD 2.18) weeks and mean birth weight of 1,525 (SD 437.5) g. The mean LV function measured by MPI was 0.281 (SD 0.075); mean EF was 72.5 (SD 5.09)%; and mean FS was 38.3 (SD 4.29)%. The RV function measured by TAPSE was mean 6.85 (SD 0.94) and that measured by MPI was median 0.255 (range 0.17-0.59). Serum hs-cTnT level was significantly higher in non-survivors than in survivors [282.08 (SD 77.81) pg/mL vs. 97.75 (24.2-142.2) pg/mL, respectively P =0.023]. There were moderate correlations between LV-MPI and hs-cTnT concentration (r=0.577; P=0.001), as well as between RV-MPI and hs-cTnT concentration (r=0.502; P=0.005). The positive correlation between LV and RV-MPI in neonatal sepsis was strong (r=0.77; P <0.001).Conclusion Left and right ventricular MPI show positive correlations with hs-cTnT levels. Serum hs-cTnT is significantly higher in non survivors. As such, this marker may have prognostic value for neonatal sepsis patients.
Blood nickel level and its toxic effect after transcatheter closure of persistent duct arteriosus using Amplatzer duct occluder Mulyadi M. Djer; Bambang Madiyono
Paediatrica Indonesiana Vol 49 No 1 (2009): January 2009
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (113.217 KB) | DOI: 10.14238/pi49.1.2009.33-8

Abstract

Background  Transcatheter closure using amplatzer  duct  occluder(ADO)  is  currently the  treatment  of  choice for  patent  ductusarteriosus (PDA).  The  ADO  device  is  constructed from a Nitinolwire mesh containing 55% nickel. Up  to  now, there  is  still acontroversy about the effects  of  nickel contained in ADO.Objectives  To  determine blood nickel level  at  six months aftertranscatheter closure  of  PDA  using  ADO,  toxic effects  of  nickelat six months after  PDA  closure using  ADO,  and the effects  ofnickel  on  complete blood  count  (CBC), blood glucose and renalfunction.Methods  Subjects  were  patients  with  PDA  at  IntegratedCardiovascular Services,  Dr.  Cipto Mangunkusumo Hospital,Jakarta. Routine blood test and blood nickel levels were measuredat  the time  of  the procedure,  and  at  the  end  of  the first, third,  andsixth months after intervention.Results  There  were  29  patients who underwent heart catheteri-zation  and  PDA closure using  ADO.  A time series analysis wasconducted  on  23  patients who completed six-month follow-upafter the intervention. Median blood nickel level before procedurewas 58 ng/mL while  at  one, three  and  six months afterwards were60, 63 and 64 ng/mL respectively.  The  blood nickel levels didnot  differ significantly between pre- and  post-ADO. After  PDAclosure,  no  toxic effects  of  nickel were found,  both  clinically andlaboratorically.Conclusions  PDA  closure using  ADO  has no effects  on  the nickellevels, CBC, blood glucose and renal function;
Comparison of minimal inhibitory and bactericidal capacity of oral penicillin V with benzathine penicillin G to Streptococcus beta--hemolyticus group A in children with rheumatic heart disease Burhanuddin Iskandar; Bambang Madiyono; Sudigdo Sastroasmoro; Sukman T. Putra; Mulyadi M. Djer; Anis Karuniawati
Paediatrica Indonesiana Vol 48 No 3 (2008): May 2008
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (233.281 KB) | DOI: 10.14238/pi48.3.2008.152-5

Abstract

Background Injection ofbenzatine penicillin G (BPG) every 28days is still the drug of choice for secondary prevention of rheu-matic heart disease (RHD). BPG sometimes poses problems dueto pain at the injection site, possible anaphylaxis, and is not alwaysavailable. Some centers choose oral penicillin over BPG.Objectives To compare minimal inhibitory capacity (MIC) andminimal bactericidal capacity (MBC) of oral penicillin V serumwith those of BPG among SGA infected RHD.Methods This was a clinical trial with crossover design study tocompare MIC of penicillin V and BPG. Outcome measures wereMIC and MBC. Statistical analysis was performed using pairedt-test and wilcoxon test.Result There were 32 subjects consisted of 17 males and 15females. The mean value of MIC and MBC serum of penicillinV were 0.031 and 0.125. The mean value of MIC and MBCserum of BPG3 were 0.094 and 0.031. Respectively the MICof penicillin V was similar to that of BPGy The mean value ofMIC and MBC of BPG4 were 0.125 and 0.250. Respectively theMIC of penicillin V was significantly higher than that of BPG 4.The MBC of penicillin V was significantly higher than that ofBPG 4. The MIC ofBPG 3 was similar to that ofBPG 4• The MBCof BPG 3 was similar to that of BPG 4.Conclusions The MIC of penicillin V was similar to that ofBPG 3,the MBC of oral penicillin V was higher than that ofBPG 3• TheMIC and MBC of penicillin V was higher than those of BPG 4.
Neutrophil-to-lymphocyte ratio as a predictor of low cardiac output syndrome after open heart surgery in children with congenital heart disease Laila, Dewi S.; Perdana, Andri; Permatasari, Ruth K.; Kadim, Muzal; Advani, Najib; Supriyatno, Bambang; Chozie, Novie A.; Djer, Mulyadi M.
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.736

Abstract

Neutrophil-to-lymphocyte ratio (NLR) as a predictor in determining low cardiac output syndrome (LCOS) has not been widely reported. The aim of this study was to explore the role of pre-surgery, 0-, 4-, and 8-hour post-surgery NLR as predictors of LCOS incidence after open heart surgery in children with congenital heart disease (CHD). This study used a prognostic test with a prospective cohort design and was conducted from December 2020 until June 2021 at the cardiac intensive care unit (CICU) of Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The subject consisted of children aged one month to 18 years who underwent open heart surgery using a cardiopulmonary bypass (CPB) machine. A receiver operating characteristic curve was applied to identify the predictive performance of NLR for poor outcomes (LCOS incidence). Out of 90 patients included in the study, 25 (27.8%) of them developed LCOS between 3 to 53 hours post-surgery. All NLR values (pre-surgery and 0-, 4-, and 8-hours post-surgery) were associated with the incidence of LCOS. Pre-surgery NLR (cut-off value ≥0.88) had a fair predictive value (area under curve (AUC) 70; 95%CI: 57–83) for predicting LCOS incidence with sensitivity and specificity of 64% and 64.62%, respectively. NLR 0-hour post-surgery (cut-off value ≥4.73) had a good predictive value (AUC 81; 95%CI: 69–94) for predicting LCOS incidence, with 80% sensitivity and 80% specificity. NLR 4- and 8-hours post-surgery had very good predictive values (AUC 97%; 95%CI: 92–100 and 98; 95%CI: 94–100, respectively), with cut-off values ≥6.19 and ≥6.78, had the same 92% sensitivity and the same 96% sensitivity. The presence of LCOS was associated with mortality (odds ratio of 5.11 with 95%CI: 3.09–8.46). This study highlights that pre-surgery, 0-, 4-, and 8-hours post-surgery NLR can be predictors of LCOS after open heart surgery in children with CHD.
Effect of the modified Atkins diet on NLRP3, caspase-1, IL-1β, and IL-10 in patients with tetralogy of Fallot undergoing open-heart surgery: A randomized controlled trial Yanuarso, Piprim B.; Djer, Mulyadi M.; Hendarto, Aryono; Pudjiadi, Antonius H.; Rachmadi, Lisnawati; Wibowo, Heri; Advani, Najib; Murni, Indah K.; Kekalih, Aria; Sukardi, Rubiana; Dilawar, Ismail; Susanti, Dhama S.; Supriatna, Novianti
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2138

Abstract

Cardiopulmonary bypass in tetralogy of Fallot (TOF) corrective surgery induces hyperinflammation by activating NLRP3, caspase-1, and interleukin-1β (IL-1β), subsequently triggering an interleukin-10 (IL-10) response. Despite its known metabolic and anti-inflammatory effects, the impact of the modified Atkins diet (MAD) in pediatric cardiac surgery remains unexplored, with no studies on its use in TOF patients undergoing open-heart surgery. The aim of this study was to assess the effect of MAD on the expression of NLRP3, caspase-1, IL-1β, and IL-10, in TOF patients undergoing open-heart surgery. A double-arm, randomized-controlled trial was conducted with 44 TOF patients. The treatment group (n=22) received the MAD, a low-carbohydrate, high-fat regimen with unrestricted fat and protein intake for at least 14 days preoperatively, while the control group (n=22) followed a standard diet without carbohydrate restriction. Blood plasma and infundibulum heart tissues were collected for analysis. Whole blood samples were collected using a winged infusion needle before the intervention, an Abbocath infusion needle after 14 days of intervention, and a syringe without a needle connected to an arterial line in patients undergoing open-heart surgery at 6, 24, and 48 hours post-surgical correction. Infundibulum heart tissues were collected during the open-heart surgery. This study demonstrated significant differences in NLRP3 protein expression (p=0.015), caspase-1 protein expression (p=0.001), and IL-10 levels between before intervention and 6-, 24-, and 48-hours post-surgery in the MAD group compared to the control group. In contrast, no significant differences in IL-10 levels were observed in the control group between before intervention and 48 hours post-surgery (p=0.654). In conclusion, MAD may modulate perioperative inflammation in TOF patients undergoing open-heart surgery by downregulating NLRP3 and caspase-1 expression while sustaining IL-10 levels. Despite reduced NLRP3 and caspase-1 expression, unchanged IL-1β levels indicate alternative regulatory mechanisms.
Evaluation of myocardial injury from use of aortic cross-clamp and cardiopulmonary bypass duration in patients undergoing tetralogy of Fallot corrective surgery Wardoyo, Suprayitno; Djer, Mulyadi M.; Busro, Pribadi Wiranda
Paediatrica Indonesiana Vol. 65 No. 2 (2025): March 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.2.2025.147-55

Abstract

Background Much remains unknown about the myocardial injury caused by aortic cross-clamp and cardiopulmonary bypass durations in children undergoing open-heart surgery, especially children with cyanotic congenital heart disease. To assess this injury, specific biomarkers can provide valuable insights. Troponin I (TnI) is known to be a specific marker of heart damage, while serum lactate serves as an indicator of tissue hypoperfusion and ischemic events. Additionally, malondialdehyde (MDA) is recognized as a marker of oxidative stress resulting from CPB machine usage. Objective To investigate the association of aortic cross clamp and CPB durations on myocardial injury and oxidative stress in children undergoing TOF corrective surgery. Methods We conducted this prospective study which included 29 patients diagnosed with TOF and who underwent corrective surgery. Troponin I and MDA levels were measured before surgery, 1 hour after surgery, and 8 hours after surgery. Lactate levels were measured in arterial blood specimens taken before surgery, as well as 1 hour, 6 hours, 12 hours, and 24 hours after surgery. Results Twenty-nine patients were included in this study and divided into groups based on aortic cross-clamp duration: shorter (<38 minutes) or longer (≥38 minutes), as well as based on CPB duration: shorter (<75 minutes) or longer (≥75 minutes), according to the median. Wilcoxon test indicated For the <38 min clamp duration group, there was only a significant increase in TnI at 1 hour compared to pre-op (P=0.048). However, there were no significant different in TnI, MDA, or lactate levels at any time point between the two CPB or cross-clamp groups.
Co-Authors Anis Karuniawati Antonius H. Pudjiadi Aria Kekalih Aryono Hendarto Bambang Madiyono Bambang Supriyatno Burhanuddin Iskandar Chozie, Novie A. Damayanti R. Sjarif Dilawar, Ismail Heri Wibowo Laila, Dewi S. Lisnawati Rachmadi Mila Maidarti Murni, Indah K. Muzal Kadim Najib Advani Najib Advani Nusarintowati Ramadhina Perdana, Andri Permatasari, Ruth K. Piprim B. Yanuarso, Piprim B. Pribadi Wiranda Busro Putri, Dyanti Prima Rahmadhany, Anisa Rinawati Rohsiswatmo Rubiana Sukardi Rubiana Sukardi, Rubiana Shirley L. Anggriawan Sudigdo Sastroasmoro Sukman T. Putra Sukman T. Putra Supriatna, Novianti Susanti, Dhama S. Wardoyo, Suprayitno