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All Journal Jurnal Veteriner Jurnal Ilmu Kedokteran (Journal of Medical Science) Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Medical Journal of Indonesia The Indonesian Biomedical Journal Sari Pediatri Paediatrica Indonesiana Narra J Jurnal Kedokteran Hewan
Antonius H. Pudjiadi
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Veterinary

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Evaluation of substrate metabolism in critically ill pediatric patients Antonius H Pudjiadi, Nurnaningsih
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 40, No 02 (2008)
Publisher : Universitas Gadjah Mada

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Abstract

Background: Critically ill pediatric patients are characterized by a hypermetabolic state, a catabolic response, and a decreased capacity to utilize substrate. Metabolic state of critically ill pediatric patients can be detected by analyzing substrate utilization.Objective: To determine the metabolic state of critically ill pediatric patients using PRISM III Score, blood glucose level, and urinary nitrogen excretion.Methods: A cross sectional study was conducted in Pediatric Intensive Care Unit (PICU) of Cipto Mangunkusumo Hospital Jakarta between May and September 2006. All admitted PICU patients, except those with renal or hepatic failure, burns, diabetic ketoacidosis and died in the first 24 hours, were included. PRISM III Scores were measured in the first 24-hours of admission. Blood glucose level was observed at random within the first hour of hospitalization, while urinary nitrogen excretion was measured using urine collected in the second 24-hours of admission.Results: Fifteen cases were eligible for this study. Their age ranged between 1 to 96 months. The median (01 ;03) for PRISM III Scores, random blood glucose, and urinary nitrogen excretion were 6.0 (3.0;11.0), 123.0 (100.0;227.0), and 279.4 (124.3;408.4) mg/dL, respectively. There were no significant correlations between PRISM III Scores and random blood glucose (r=0.40;p=0.14), and between PRISM III Scores and urinary nitrogen excretion (r = -0.27;p = 0.33). There was significant correlation between random blood glucose and urinary nitrogen excretion (r=0.56;p=0.03).Conclusion: Critically ill pediatric patients had a catabolic state that had no association with PRISM III Scores. Random blood glucose level within the first hour of admission predicted the increasing protein catabolism.Key words: critically ill pediatric patients - blood glucose level - urinary nitrogen excretion - PRISM III Score.
Correlation between urinary albumin to creatinine ratio and systemic glycocalyx degradation in pediatric sepsis Saragih, Rina A.C.; Pudjiadi, Antonius H.; Tambunan, Taralan; Satari, Hindra I.; Aulia, Diana; Bardosono, Saptawati; Munasir, Zakiudin; Lubis, Munar
Medical Journal of Indonesia Vol 27, No 3 (2018): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (410.216 KB) | DOI: 10.13181/mji.v27i3.2156

Abstract

Background: Increased capillary permeability in sepsis is associated with several complications and worse outcomes. Glycocalyx degradation, marked by increased serum syndecan-1 levels, alters vascular permeability, which can manifest as albuminuria in the glomerulus. Therefore, elevated urinary albumin to creatinine ratio (ACR) potentially provides an index of systemic glycocalyx degradation. The aim of this study was to analyze the correlation between urinary ACR and serum syndecan-1 levels.Methods: A longitudinal prospective study with repeated cross-sectional design was conducted on children with sepsis in pediatric intensive care unit, we evaluated serum syndecan-1 levels and urinary ACR on days 1, 2, 3, and 7. A descriptive study on healthy children was also conducted to determine the reference value of syndecan-1 in children.Results: 49 subjects with sepsis were recruited. Based on the data of the healthy children group (n=30), syndecan-1 level of >90th percentile (41.42 ng/mL) was defined as systemic glycocalyx degradation. The correlation coefficients (r) between urinary ACR and syndecan-1 levels were 0.32 (p<0.001) from all examination days (162 specimens), 0.298 (p=0.038) on day 1, and 0.469 (p=0.002) on day 3. The area under the curve of urinary ACR and systemic glycocalyx degradation was 65.7% (95% CI 54.5%–77%; p=0.012). Urinary ACR ≥157.5 mg/g was determined as the cut-off point for glycocalyx degradation, with a sensitivity of 77.4% and a specificity of 48%.Conclusion: Urinary ACR showed a weak correlation with systemic glycocalyx degradation, indicating that the pathophysiology of elevated urinary ACR in sepsis is not merely related to glycocalyx degradation.
Peningkatan Kadar Troponin-I Paska Resusitasi Cairan pada Sus Scrofa Sebagai Model Hewan Coba Renjatan Hotber E. R. Pasaribu; Antonius H Pudjiadi; Rismala Dewi
Jurnal Ilmu Kedokteran Vol 12, No 1 (2018): Jurnal Ilmu Kedokteran
Publisher : Fakultas Kedokteran Universitas Riau

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (75.355 KB) | DOI: 10.26891/JIK.v12i1.2018.7-12

Abstract

Provision large amounts of fluids in a short period is known can cause hypervolemia. Therefore, an examination is needed to find out that the fluid resuscitation being administered does not cause hypervolemia. The purpose of this study is to assess the effect of hypervolemic resuscitation on cardiac contractility. The study was conducted on 10 male Sus Scrofa aged 6-8 weeks, as shocked animal models. There are 3 types of resuscitation treatments : normovolemic, hypervolemic-1, and hypervolemic-2. Cardiac contractility was assessed using DPmax and troponin-i levels. There was an increase in troponin-i levels after hypervolemic fluid resuscitation (p = 0.05). There is a decrease in cardiac contractility after hypervolemic resuscitation. Decreased cardiac contractility is associated with increased troponin-i (r = 0.720; p = 0.020). Based on the results, we conclude hypervolemic resuscitation causes changes in troponin-i levels, which reflect changes in cardiac contractility.
Gambaran Kelistrikan Jantung Anak Babi pada Kondisi Renjatan dengan Resusitasi Hipervolemik Menggunakan Cairan Kristaloid Natrium Chlorida 0,9% Gunanti Gunanti; Soesatyoratih Soesatyoratih; Antonius H Pudjiadi; Melpa Susanti Purba; Galih Satria Kusumanto
Jurnal Veteriner Vol 21 No 1 (2020)
Publisher : Faculty of Veterinary Medicine, Udayana University and Published in collaboration with the Indonesia Veterinarian Association

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Abstract

This study aimed to determine the effect of resuscitation and hypervolemic conditions on shocked piglet’s heart electrical system. Animal models that were used in this study are 5 healthy castrated piglets. The piglet’s blood were withdrawn until the mean arterial pressure dropped about 20 % from the baseline condition to make a hypovolemic shock condition. When the piglets reached the hypovolemic shock state, fluid resuscitation using crystalloid (NaCl 0.9 %) as much as 40 ml/kg were given using a 50 ml syringe through the jugular vein. ECG examination were performed before surgery and when it reached the hypervolemic state after being resuscitated. The ECG results indicate no apparent change in cardiac performance due to the absence of ECG waveform changes from waveforms during normal conditions. In conclusion, crystalloid fluid resuscitation (NaCl 0.9 %) until hypervolemic condition does not interfere with cardiac performance.
Citrullinated Histone H3 Level as a Novel Biomarker in Pediatric Clinical Sepsis Ronald Chandra; Antonius Hocky Pudjiadi; Rismala Dewi
The Indonesian Biomedical Journal Vol 13, No 3 (2021)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v13i3.1597

Abstract

BACKGROUND: Sepsis is still leading cause of death in critically ill children. Early recognition of sepsis and treatments are needed to reduce its mortality. The use of citrullinated Histone H3 (Cit-H3) as an early sepsis marker and outcome predictor has been validated in previous studies among adults. However, only one study in pediatric meningococcal sepsis was reported with contradictory results. This study aims to determine Cit-H3 levels in pediatric clinical sepsis and analyze its association with sepsis severity and survival rate.METHODS: A prospective observational cohort study involving 67 pediatric subjects clinically diagnosed with sepsis was conducted. Cit-H3 levels, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score, and Pediatric Sequential Organ Failure Assessment (pSOFA) score were assessed at the time of diagnosis (0-hour) and 48 hours later. Pearson Correlation test was used to determine the correlation between Cit-H3 levels with PELOD-2 and pSOFA scores and receiver operating curve to find the cut-off of Cit-H3 levels on clinical sepsis patients.RESULTS: Among clinically sepsis patients, the median Cit-H3 level was 1,210 (800-32,160) ng/mL, with optimal cut-off point ≥1200 ng/mL (sensitivity 83.3% and specificity 75.7%) to discriminate sepsis. The median Cit-H3 levels at 0-hour were lower in survivor compared to non-survivor group (p=0.016). Cit-H3 level was able to predict mortality with optimal cut-off point ≥1,200 ng/mL, sensitivity 72.2% and specificity 57.1% (AUC of 69.2%; p=0.017). Using survival analysis, Cit-H3 was significantly associated with the mortality rate (p=0.023; hazard ratio of 3.45).CONCLUSION: Cit-H3 level could be potential to predict pediatric sepsis events and its outcome.KEYWORDS: citrullinated histone H3, neutrophil extracellular traps, pediatric sepsis, PELOD-2 score, pSOFA score, survival
Plasmaferesis Sebagai Terapi Sindrom Guillain-Barre Berat pada Anak Vimaladewi Lukito; Irawan Mangunatmadja; Antonius H. Pudjiadi; Tatang M. Puspandjono
Sari Pediatri Vol 11, No 6 (2010)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp11.6.2010.448-55

Abstract

Plasmaferesis atau plasma exchange merupakan salah satu pilihan terapi bagi sindrom Guillain-Barreberat. Beberapa penelitian menunjukkan bahwa plasmaferesis dan imunoglobulin intravena (IVIg) sebagaiterapi sindrom Guillain-Barre memiliki efektivitas yang sama, namun penggunaan plasmaferesis padapasien anak lebih jarang dilakukan karena membutuhkan peralatan dan persiapan yang lebih kompleks.Tujuan dari laporan kasus untuk melaporkan terapi sindrom Guillain-Barre berat dengan menggunakanplasmaferesis pada pasien anak. Seorang anak perempuan usia 10 tahun dirawat di RSUPN. Dr. CiptoMangunkusumo dengan diagnosis sindrom Guillain-Barre. Pada hari kedua perawatan pasien mengalamiparalisis otot pernafasan sehingga pernafasan harus dibantu dengan ventilasi mekanik. Faktor ekonomi danketersediaan alat menyebabkan plasmaferesis dipilih sebagai terapi, dibandingkan dengan pengobatan IVIg.Plasmaferesis dilakukan empat kali dalam waktu satu minggu dengan menggunakan fraksi protein. Efeksamping plasmaferesis berupa hipotensi dan sepsis yang ditangani dengan pemberian cairan dan antibiotik.Fungsi motorik pasien berangsur membaik dalam waktu satu minggu. Ventilasi mekanik dilepas setelahduapuluh enam hari dan pasien dipulangkan setelah dua bulan perawatan. Plasmaferesis dan IVIg memilikiefektifitas yang sama sebagai terapi sindrom Guillain-Barre berat. Keputusan untuk memilih salah satu terapitersebut berdasarkan pada keadaan klinis pasien, sistem penunjang, dan kemampuan ekonomi orang tuapasien.
Hiponatremia pada Anak Pasca Tindakan Operasi : Etiologi dan Faktor-faktor yang Berhubungan Angelina Arifin; Antonius H. Pudjiadi; Setyo Handryastuti; Idham Amir; Evita B. Ifran; Mulya R. Karyanti
Sari Pediatri Vol 19, No 2 (2017)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (89.149 KB) | DOI: 10.14238/sp19.2.2017.63-70

Abstract

Latar belakang. Kejadian hiponatremia pada anak pasca-operasi berkisar antara 20-40%. Hiponatremia yang tidak terdeteksi dapat meningkatkan mortalitas dan menyebabkan luaran neurologis yang buruk. Beberapa mekanisme yang berperan adalah sindrom hormon antidiuretik tidak tepat (SHATT) dan sick cell syndrome (SCS). Tujuan. Mengetahui insidens hiponatremia pada anak pasca-operasi, kemungkinan penyebab yang melatarbelakangi, serta faktor yang berhubungan.Metode. Penelitian potong lintang analitik dilakukan di ruang perawatan intensif terhadap anak berusia 1 bulan sampai 18 tahun yang menjalani tindakan operasi mayor dan masuk ruang perawatan intensif pediatrik RSCM selama bulan Mei sampai Desember 2016.Hasil. Terdapat 65 subyek menjalani operasi mayor, 87,69% dilakukan secara elektif, jenis operasi terbanyak adalah hepato-gastrointestinal (38,46%) dan muskuloskeletal (20,00%). Kadar natrium plasma pasca-operasi turun, kejadian hiponatremia 43,07% dan 26,16% pada 12 dan 24 jam pasca-operasi. Nilai osmolalitas plasma yang normal atau meningkat dan osmolalitas urin >100 mOsm/kg. Sebanyak 70% subyek hiponatremia memiliki natrium urin >30 mEq/L. Faktor yang berhubungan dengan hiponatremia 12 jam pasca-operasi adalah status kegawatdaruratan operasi (p=0,007) dan perdarahan intraoperatif (p=0,024), sedangkan pada 24 jam pasca-operasi hanya status kegawatdaruratan operasi (p=0,001).Kesimpulan. Terdapat 43,07% dan 26,16% subyek yang mengalami hiponatremia pada 12 dan 24 jam pasca-operasi mayor. Sindrom hormon antidiuretik tidak tepat tidak terbukti menjadi penyebab utama terjadinya hiponatremia, dan hiponatremia translokasional pada SCS mungkin berperan. Hiponatremia pasca-operasi berhubungan dengan status kegawatdaruratan operasi dan jumlah perdarahan intraoperatif.
Pedoman Resusitasi Syok Septik “Surviving Sepsis Campaign” Butuh Penyesuaian Antonius Hocky Pudjiadi
Sari Pediatri Vol 21, No 5 (2020)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp21.5.2020.329-32

Abstract

Surviving sepsis campaign (SSC) mengeluarkan pedoman tata laksana klinis pasien sepsis. Pedoman tata laksana ini dibuat atas dasar ilmu kedokteran berbasis bukti berdasarkan data pasien sepsis dewasa. Dalam panduannya, terdapat target-target tata laksana yang perlu dicapai dalam batas waktu tertentu, termasuk target hemodinamik sebagai panduan resusitasi, seperti jumlah cairan resusitasi, rerata tekanan arteri, dan tekanan vena sentral. Makalah ini bertujuan untuk mengupas permasalahan dari adaptasi target SSC, khususnya pada pasien anak di Indonesia.
Insidens Kandidemia di Paediatric Intensive Care Unit Rumah Sakit Dr. Cipto Mangunkusumo Doddy Kurnia Indrawan; Antonius H Pudjiadi; Abdul Latief Latief
Sari Pediatri Vol 18, No 3 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (84.865 KB) | DOI: 10.14238/sp18.3.2016.182-6

Abstract

Latar belakang. Kandidemia menjadi salah satu masalah di PICU, angka ejadiannya meningkat setiap tahun dengan angka kematian yang tinggi, serta memperpanjang masa rawat di rumah sakit. Sampai saat ini, data insidens kandidemia pada anak masih terbatas.Tujuan. Mengetahui insidens kandidemia di PICU RSCM.Metode. Penelitian retrospektif dilakukan di RS Cipto Mangunkusumo dengan mencatat data rekam medis pasien kandidemia pada anak periode 1 Januari 2013 sampai 31 Desember 2014. Hasil. Didapatkan 32 kejadian kandidemia dalam kurun waktu pengambilan data. Median usia pasien 12,8 bulan, 57,7% berjenis kelamin laki-laki. Sebagian besar pasien mengalami gizi kurang, 69,2% kasus bedah dan 30,8% non bedah. Penggunaan steroid 11,5%. Selama perawatan di PICU, 96,2% pasien menggunakan ETT, 100% menggunakan kateter vena sentral dan kateter urin. Pasien yang menggunakan antibiotik >15 hari 80,8%. Median skor awal PELOD adalah 12. Median waktu pemberian anti jamur 15,8 hari perawatan di PICU, luaran hidup 65,4%, rerata lama rawat PICU 25,8 hari. Penyakit yang mendasari perawatan di PICU 7,7% infeksi saluran pernapasan, 3,8% infeksi sistem saraf, 19,2% syok sepsis, 3,8% pascabedah kepala leher, 11,5% pasca bedah dada, dan 53,8 pasca bedah abdomen. Rerata lama pemggunaan ETT 10,04 hari, kateter vena sentral 15,65 hari, dan kateter urin 11,15 hari. Jenis kandida terbanyak adalah kandida parapsilosis. Lebih dari dua antibiotik diberikan pada 76,8% pasien sebelum mendapatkan anti jamur.Kesimpulan. Kejadian kandidemia serupa dengan negara berkembang lainnya dan ditemukan meningkat pada pasien dengan status gizi kurang, pasacabedah, penggunaan alat medis invasif, dan penggunaa antibiotik >15 hari.
Validitas Stroke Volume Variation dengan Ultrasonic Cardiac Output Monitor (USCOM) untuk Menilai Fluid Responsiveness I Nyoman Budi Hartawan; Antonius H Pudjiadi; Abdul Latief; Rismala Dewi; Irene Yuniar
Sari Pediatri Vol 17, No 5 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (184.003 KB) | DOI: 10.14238/sp17.5.2016.367-372

Abstract

Latar belakang. Stroke volume variation (SVV) adalah parameter hemodinamik untuk menilai fluid responsiveness. Pengukuran SVV dapat dilakukan dengan USCOM yang merupakan alat pemantauan hemodinamik non invasif berbasis ekokardiografi Doppler.Tujuan. Mengetahui nilai cut-off point (titik potong optimal) SVV dengan USCOM sebagai prediktor fluid responsiveness pada pasien dengan ventilasi mekanik.Metode. Penelitan dilaksanakan di Pediatric Intensive Care Unit (PICU) dan Unit Gawat Darurat (UGD) Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta. Penelitian ini merupakan uji diagnostik dengan menggunakan peningkatan stroke volume (SV) setelah challenge cairan ringer laktat 10 mL/kg berat badan selama 15 menit sebagai indek. Subyek penelitian adalah pasien dengan usia ≥1 bulan dan ≤18 tahun yang menggunakan ventilasi mekanik. Peningkatan nilai SV ≥10% disebut responder dan <10% disebut non responder. Pengukuran SV dengan USCOM dilakukan sebelum dan setelah fluid challenge, dan pengukuran SVV dilakukan sebelum challenge cairan.Hasil. Terdapat 32 subyek ikut serta dalam penelitian. Area under curve (AUC) subyek ventilasi mekanik adalah 76,6% (IK95%:60,1%-93,1%), p<0,05. Titik potong optimal SVV adalah 30%, dengan sensitivitas 72,7% dan spesisifitas 70%.Kesimpulan. Ultrasonic cardiac output monitor (USCOM) memiliki validitas yang baik untuk menilai SVV pada pasien dengan ventilasi mekanik. 
Co-Authors Abdul Latief Abdul Latief Abdul Latief Abdul Latief Latief Agung G. Tanurahardja Ahmad Arif Amin Aland Roland Tumbelaka Aman Pulungan Amir Thayeb Angelina Arifin Aria Kekalih Arwin A. P. Akib Aryono Hendarto Badriul Hegar Bambang Supriyatno Bambang Tridjaja AAP, Bambang Tridjaja Damayanti R. Syarif Darlan Darwis Desy Dewi Saraswati Diana Aulia Dilawar, Ismail Doddy Kurnia Indrawan Dwi Putro Widodo E.M. Dady Suyoko Emi Yulianti Evita B. Ifran Evita Kariani B. Ifran Fathema D Rachmat Galih Satria Kusumanto Gunanti . Gunanti Gunanti Hari Kushartono Heri Wibowo Hindra I. Satari, Hindra I. Hindra Irawan Satari Hotber Pasaribu I Nyoman Budi Hartawan Idham Amir Idham Amir Imral Chair Irawan Mangunatmadja Irene Yuniar, Irene Johnny Nurman Jusuf Rachmat Lina Haryanti Lisnawati Rachmadi Mardjanis Said Melpa Susanti Purba Meri Yanti Mulya R. Karyanti Mulyadi M. Djer Mulyadi M. Djer Munar Lubis Murni, Indah K. Najib Advani Najma Hayati Ni Made Rini Suari Nia Kurniati Nina Dwi Putri Nindya Permata Piprim B. Yanuarso, Piprim B. Pramita G. Dwipoerwantoro Pramita Gayatri R. Irma Rachmawati Raden Roro Soesatyoratih Rina A.C. Saragih, Rina A.C. Ririe F Malisie Rismala Dewi Ronald Chandra Rubiana Sukardi, Rubiana Saptawati Bardosono Setyo Handryastuti Supriatna, Novianti Susanti, Dhama S. Susetyo Harry Purwanto Taralan Tambunan Tartila Fathan Tatang M. Puspandjono Vimaladewi Lukito Yosilia Nursakina Zakiudin Munasir