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All Journal Medical Journal of Indonesia The Indonesian Biomedical Journal Sari Pediatri Paediatrica Indonesiana Majalah Kedokteran Nusantara The Journal Of Medical School Sumatera Medical Journal Cermin Dunia Kedokteran Cermin Dunia Kedokteran

Munar Lubis

Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Sumatera Utara

Author-ID : 565435

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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PELOD score, serum procalcitonin, and lactate levels in pediatric sepsis Jufitriani Ismy; Munar Lubis; Erna Mutiara; Gema Nazri Yani; Yunnie Trisnawati
Paediatrica Indonesiana Vol 55 No 6 (2015): November 2015
Publisher : Indonesian Pediatric Society

Background Sepsis remains a major cause of morbidity and mortality among critically ill children in the pediatric intensive care unit (PICU). Procalcitonin and lactate have been used as biomarkers of sepsis, as they have been correlated with disease severity, organ failure and death. The Pediatric Logistic Organ Dysfunction (PELOD) score is a tool to assess the severity of organ dysfunction in critically ill children. Objective To investigate the correlation between PELOD score and procalcitonin and lactate levels in pediatric sepsis. Methods A cross-sectional study was conducted in children with sepsis who were admitted to the PICU from April to July 2012. Sepsis was defined as systemic inflammatory response syndrome (SIRS), as a result of suspected or proven infection. Proven infection was defined as positive culture findings (blood, urine or other specimens) and/or serum procalcitonin >=2 ng/mL. Spearmanâ€™s test was used to assess for correlations between PELOD scores and procalcitonin as well as lactate levels. Results Thirty-two patients were analyzed, consisting of 18 males and 14 females with an age range of 1-432 months (median 21 months). There was no statistically significant correlation between procalcitonin level and PELOD score (r=- 0.186, 95%CI -0.502 to 0.174, P=0.308) nor between lactate level(r=-0.069, 95%CI -0.408 to 0.287, P=0.709) and PELOD score. Conclusion Serum procalcitonin and lactate levels are not correlated with PELOD scores in children with sepsis.

Comparison of SpO2/FiO2 and PaO2/FiO2 ratios as markers of acute lung injury Dewi Shandi Laila; Chairul Yoel; Hakimi Hakimi; Munar Lubis
Paediatrica Indonesiana Vol 57 No 1 (2017): January 2017
Publisher : Indonesian Pediatric Society

Background One of the diagnostic criteria for acute lung injury (ALI) is the PaO2/FiO2 (P/F) ratio. This measurement is obtained by blood gas analysis, which involves an invasive procedure (arterial blood draw). In order to reduce invasive procedures on critically ill patients, an alternative non-invasive marker for ALI is needed. The SpO2/FiO2 (S/F) ratio attained by pulse oximetry may be a suitable alternative.Objective To investigate for a correlation between S/F ratio and P/F ratio, in order to find an alternative non-invasive marker of ALI.Methods A cross-sectional study was conducted in the pediatric intensive care unit (PICU) at Haji Adam Malik Hospital, Medan from August 2012 to June 2013. Subjects (children aged 1 month â€“ 18 years) underwent blood gas analysis when their pulse oximetry showed saturation of 80-97% within 24 hours of ventilator use. We measured PaO2, SpO2, and FiO2 and calculated S/F and P/F ratios. Data were analyzed by Spearmanâ€™s correlation and linear regression tests.Results Of 69 PICU patients, 39 children fulfilled the criteria for ALI. The S/F ratio and P/F ratio had a weak correlation (r=0.2; P=0.18). The linear regression equation was S/F ratio = 129.67 + 0.11 (P/F), with S/F ratio values of 162.67 and 151.67 correlating to P/F ratio values of 300 and 200, respectively.Conclusion Â The S/F ratio has a weak correlation with P/F ratio for ALI in children.Â Â

Effect of length of albendazole treatment against Trichuris trichiura infection Aridamuriany D Lubis; Syahril Pasaribu; Muhammad Ali; Munar Lubis
Paediatrica Indonesiana Vol 53 No 5 (2013): September 2013
Publisher : Indonesian Pediatric Society

Background Trichuris trichiura is one of the most common soil-transmitted helminth that infects school-aged children. A single dose of albendazole has been shown to have wide variations in cure and egg reduction rates. Some studies have suggested that repeated doses of albendazole might increase its effectiveness.Objective To compare the anti-trichuriasis effect of 400 mg albendazole taken daily for five consecutive days vs. seven consecutive days.Methods A randomized open clinical trial was conducted from August to September 2009 on elementary school children at Jaring Halus in the North Sumatera Province. Stool specimens were collected before treatment and on days 7, 14, 21, and 28 after initiation of treatment, and examined by the Kato Katz method. Subjects were randomized into two groups. Group I received 400 mg albendazole daily for five consecutive days and Group II received 400 mg albendazole daily for seven consecutive days. Cure rates and egg reduction rates were compared using Chi-square and T-tests, respectively.Results One hundred twenty-one children were enrolled, consisted of 61 children in Group I and 60 in Group II. For the first week after treatment ended, the cure rates in Group II was higher (86.7%) than in the Group I (39.3%) (P=0.001), as well as in the second week after treatment ended (88.3% vs 68.9%, P=0.017). However, after 3rd and 4th weeks, the cure rates were no longer significantly different. Egg reduction rate was also statistically higher in the Group II [20.3 (SD 23.77) %] compared to Group I [6.6 (SD 11.30) %].Conclusions Albendazole for seven consecutive days is more effective in curing Trichuris trichiura infection in the 1st and 2nd weeks after treatment compared to that of five consecutive days, as well as in egg reduction rate, but the length of treatment does not influence the cure rate after the 3rd and 4th weeks.

Red cell distribution width and mortality in pediatric sepsis Trina Devina; Munar Lubis; Erna Mutiara; Gema Nazri Yanni; Rina Amalia C. Saragih; Yunnie Trisnawati; Aridamuriany Dwiputri Lubis; Putri Amelia
Paediatrica Indonesiana Vol 56 No 6 (2016): November 2016
Publisher : Indonesian Pediatric Society

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 patientsâ€™ RDW were collected within 24 hours of sepsis diagnosis. We determined the association between RDW and hemoglobin (Hb) using Spearmanâ€™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. Subjectsâ€™ 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.Â

Parental knowledge, attitude and practice on malaria in Mandailing Natal district Syafruddin Haris; Sri Sofyani; Bidasari Lubis; Munar Lubis; Syahril Pasaribu; Iskandar Z. Lubis
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Background Malaria is still considered to be an important healthproblem in Indonesia. Malaria has been found in islands withdifferent degree of endemicity. Behavior of the community isone of the factors affecting the incidence of malaria in MandailingNatal district.Objective To know the parental knowledge, attitude, and practiceamong parents whose children suffered from malaria or not.Methods A cross sectional study was conducted in six primaryschools and one health centre in October 2004. Subjects wereparents whose children were malaria positive and malaria negativebased on laboratory examination. Sample size was 85 parents foreach group. Selected respondents were interviewed usingstructured questionnaire. Degree of knowledge, attitude, andpractice on malaria were established using scoring system withinthree categories: good, less, and poor. Data were collected andpresented using chi-square and P<0.05 was considered as a levelof significant.Results The mean age of 85 parents whose children were positivemalaria, was 38.47 years (SD 6.67) and the mean age of thosewhose children were negative malaria was 40.41 years (SD 8.05).Parentâ€™s education level was 62.9% primary school and 90% oftheir children were school-aged. There were significant differenceson parental knowledge, attitude and practice in each group(P<0.05). There was also a significant correlation betweenoccupation and knowledge, but not between parental educationlevel and parental age. Parental knowledge and attitude on theincidence of malaria in Mandailing Natal district were good,though their practice were poor.Conclusion There are significant differences on parentalknowledge, attitude and practice, between parents whose childrenwere positive and negative for malaria.

Effect of oral glucose administration on pain in neonates undergoing peripheral blood collection Effa Triani; Munar Lubis; Chairoel Yoel
Paediatrica Indonesiana Vol 47 No 4 (2007): July 2007
Publisher : Indonesian Pediatric Society

Background Peripheral blood sampling with heel sticks in neonatescould represent minor invasive procedure which generates pain.The oral glucose administration can reduce the pain in neonatesduring this procedure.Objective To compare the pain sense after oral glucoseadministration or placebo during peripheral blood sampling withheel sticks in neonates.Methods A double blind randomized clinical trial study wasconducted from January to March 2004 in three teaching hospitalsin Medan. The population of this study was divided into twogroups (glucose and placebo) and each group consisted of 32neonates. The intervention group got 1 ml of 40% glucose andthe placebo group got 1 ml of sterile water. Blood sample wastaken with sterile hemolet with heel sticks from healthy atermneonates. The pain was measured using NIPS score and measuredin first 30 seconds after heel sticking. The heart and respiratoryrate measurement was done before and during the interventionand we also counted crying time. Data were analyzed with studenttâ€“test.Results The significant mean difference of NIPS score in glucosegroup was 2.22 (SD 0.83) vs 4.72 (SD 0.96) in placebo group(P<0.0001). There was significant mean difference of crying time,i.e. 0.16 (SD 0.37) in glucose group vs 2.05 (SD 0.77) in placebogroup (P<0.0001). There was significant differences of heart ratebefore and during heel sticking in both groups.Conclusion There were some differences of pain sense in neonateswho received 40% glucose compared to those who received sterilewater during peripheral blood sampling.

Treatment of intestinal helminthiasis: mebendazole only or mebendazole-pyrantel pamoate? Wisman Dalimunthe; Charles Siregar; Munar Lubis; Syahril Pasaribu; Chairuddin P. Lubis
Paediatrica Indonesiana Vol 47 No 5 (2007): September 2007
Publisher : Indonesian Pediatric Society

Background Although intestinal helminthiasis causes highmorbidity and has a negative impact on childrenâ€™s growth anddevelopment, the efficacy of antihelmintics for multiplehelminthiasis in mass treatment is still doubtful.Objective To compare the efficacy of single dose mebendazoleand a combination of pyrantel pamoate and mebendazole for thetreatment of multiple infections due to Ascaris lumbricoides,hookworm, and Trichuris trichiura.Methods Subjects were elementary school students in Suka Village,Tiga Panah subdistrict, North Sumatera. They were randomizedto either receive mebendazole (M Group) or mebendazole-pyrantel pamoate group (MP Group). Stool examinations wereperfomed on each subjects on day 7, 14, 21, and 28 after treatment.Analyses were perfomed by using chi-squared and Mann-WhitneyU tests.Results The prevalence of intestinal helminthiasis was 95.4%. T.trichiura (88.7%) was the most common cause of infection followedby A. lumbricoides (79.5%), and hookworm (3.1%). Two hundredthirty nine (76.8%) children had multiple infections. Althoughthe egg reduction rate of intestinal helminthiasis in thecombination group was faster than that of the mebendazole group,there was no significant difference in the cure rate of both groups.Conclusion A single dose of mebendazole is preferred for masstreatment of multiple intestinal helminthiasis infections.

Effect of iron and zinc supplementation in the treatment of malaria in children Danny Dasraf; Bugis Mardina Lubis; Bidasari Lubis; Nelly Rosdiana; Munar Lubis; Syahril Pasaribu
Paediatrica Indonesiana Vol 47 No 6 (2007): November 2007
Publisher : Indonesian Pediatric Society

Background Iron and zinc administration for children withmalaria in endemic area were known to decrease parasitemia butdata on their effectiveness when given together to increasereticulocytes as erythropoiesis parameter and hemoglobin isinsufficient.Objective To determine the effect of zinc to increase ironabsorption in the treatment of Plasmodium falciparum malaria inchildren.Methods Children with positive Plasmodium falciparum on theirblood smear (n=86) examination were randomly assigned to dailysupplementation of iron 6 mg per kg body weight per day plusplacebo or iron plus zinc 10 mg per day for 30 days. Venous bloodspecimens were collected at the start and at the end of the study.Results Sixty-nine children completed the supplementations andhad both baseline and follow-up blood specimen study. After 30-day supplementation, the iron plus placebo and iron plus zincgroups showed significant difference on hemoglobin concentration(0.58 and 0.09 g/dl; P<0.05). There was no significant differencein reticulocyte production index and reticulocyte count beforeand after intervention in both groups. There was only significantdifference in red blood cells concentration after supplementationof iron plus placebo and iron plus zinc (4.7 in 4.5 million/Î¼l;P<0.05).Conclusions Iron supplementation with or without zinc showssignificant increase of hemoglobin concentration. It is slightlyhigher in iron plus placebo group.

Efficacy of artemether-lumefantrine and artesunate-amodiaquine for treating uncomplicated falciparum malaria in children Tri Faranita; Ayodhia Pitaloka Pasaribu; Muhammad Ali; Munar Lubis; Syahril Pasaribu
Paediatrica Indonesiana Vol 52 No 5 (2012): September 2012
Publisher : Indonesian Pediatric Society

Background Artesunate-amodiaquine (ASAQ) has been usedas a firsdine treatment for uncomplicated faldparum malariain Indonesia since 2004. Its efficacy depends on amodiaquineresistance of the infecting parasites. Artemether-lumefantrine(AL) has been shown to be highly efficacious in treatinguncomplicated faldparum malaria in several countries. However,there have been few studies on these anti-malarial medicationsin Indonesia.Objective To compare the efficacy of AL to ASAQ for treatinguncomplicated faldparum malaria in children.Methods An open, randomized, controlled trial wasconducted in school-aged children in the Mandailing NatalRegency, North Sumatera Province, Indonesia, from Octoberto December 2010. A total of 280 pediatric, uncomplicatedfalciparum malaria patients were randomly assigned to receiveeither AL or ASAQ for 3 days. Participants were followed-up ondays 1,2,3,7, 14, 28 and 42 following the first medication dose.The outcomes noted were adequate clinical and parasitologicalresponse (ACPR), parasite reduction, parasite clearance time,fever clearance time and adverse events. Analysis was basedon intention-to-treat.Results In this study, ACPRs on day 42 were 86.4% and 90.7%for the ASAQ and AL groups, respectively (p=0.260). On days 7and 14, the AL group had higher cure rates than that of the ASAQgroup (P<0.05). Early treatment failure, late treatment failure andparasitological failure for both groups were similar. We also foundfaster parasite clearance time and higher parasite reduction in theAL group than in the ASAQ group. However, fever clearancetime was shorter in the ASAQ group. The incidence of adverseevents such as nausea, vomiting, malaise, and pruritus were similarbetween the two groups (P=0.441).Conclusion AL had higher efficacy than ASAQ for the treatment of uncomplicated falciparum malaria in children.[Paediatr rndones. 2012;52:260-6].

Short-term impact of acute uncomplicated malaria on the cognitive performance of school children living in an endemic area Masyitah Masyitah; Lily Rahmawati; Sri Sofyani; Munar Lubis; Iskandar Z. Lubis
Paediatrica Indonesiana Vol 49 No 2 (2009): March 2009
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi49.2.2009.82-6

Background In Indonesia, malaria remains a public healthproblem. In North Sumatra between 2000 and 2004, an estimated50,670 clinical cases occurred every year, leading to the deathsof 9-10 people per year.Objectives To determine the short-term impact of acute uncompli-cated malaria on the cognitive performance of school children.Methods A prospective study was conducted on students at fourelementary schools in Madina, North Sumatra, Indonesia, fromAugust 15 to September 3, 2006. Subjects were classified intomalaria and non-malaria groups based on microscopically confirmedblood smears; they were selected by means of random sampling.Cognitive performance was measured with two examination paperson mathematics and Indonesian language before and two weeksafter artesunate and amodiaquin treatment for three days in themalaria group. Independent or paired t-tests were used to analyzedifferences in mean scores of cognitive performance.Results From 925 children examined, 384 suffered from malaria.One-hundred and thirty three children were recruited from themalaria group and 132 children were recruited from the non-malaria group. There was no difference in the distribution ofgeneral characteristics of the subjects. There was a significantdifference in cognitive performance between the malaria andnon-malaria groups (P<0.0001) before and after treatments. Inthe malaria group, there was a significant difference in cognitiveperformance before (mean 38.9; SD 15.19) and after treatment(mean 72.9; SD 10.41) with P<O.OOOl.Conclusion Acute uncomplicated malaria significantly affectsthe cognitive performance of school children living in a malaria-endemic area.

Co-Authors Adillida Adillida Aileen Clarissa Dauhan Amir S. Madjid, Amir S. Antonius H. Pudjiadi Aridamuriany D Lubis Aridamuriany D Lubis Aridamuriany D. Lubis Aridamuriany Dwiputri Lubis Aridamuriany Dwiputri Lubis Armila Armila Arto, Karina Sugih Austin Simon Tjowanta Ayodhia P. Pasaribu Ayodhia Pitaloka Pasaribu Bambang Supriyatno Beatrix Siregar Beatrix Siregar, Beatrix Bidasari Lubis Bugis Mardina Lubis C. Saragih, Rina Chaerul Yael Chairoel Yoel Chairuddin P. Lubis Chairuddin P. Lubis Chairuddin P. Lubis Chairul Yoel Chairul Yoel Chairul Yoel Chairul Yoel Chairul Yoel Chairul Yoel, Chairul Charles Siregar Charles Siregar Cynthea Prima Destariani Danny Dasraf Dewi Shandi Laila, Dewi Shandi Diana Aulia Dini Lailani Ditho Athos P. Daulay Effa Triani Effa Triani Efori Gea Elmeida Effendy Ema Mutiara Emil Azlin Emil Salim Endang D. Hamid Erika S. Panjaitan Erna Mutiara Erna Mutiara Erna Mutiara Erniwaty P Panggabean Fauzi Rizal Fujiati, Isti Ilmiati Gabriel P. Gema N. Yanni Gema Nazri Yani Gema Nazri Yanni Gema Nazri Yanni Gema Nazri Yanni Gunanti . Hakimi Hakimi Hasibuan, Syahreza Helmi M. Lubis Hendy Zulkarnain Hindra I. Satari, Hindra I. Ichwan HH Batubara Indah Nur Lestari Iskandar Z Lubis Iskandar Z. Lubis Isra Firmansyah Isra Firmansyah Isti Ilmiati Jenny Ginting Johannes H. Saing Johnny Arsyad Jose Rizal Latief Batubara Jose RL Batubara Jufitriani Ismy Jufitriany Ismi Kristina Ambarita Kristina Ambarita Lestari, Indah Nur Lily Irsa Lily Rahmawati Lubis, Inke Nadia Mahadi Mahadi Manihar D. Marbun Melda Deliana Melda Deliana Melda Deliana Monalisa Elizabeth Muhammad Adib Mahara Muhammad Ali Muhammad Ali Muhammad Ali Nafianti, Selfi Nasution, Badai Buana Nelly Rosdiana Nora Sovira Oke Rina Ramayani Oke Rina Ramayani Oke Rina Ramayani, Oke Rina Purnama Fitri Putri Amelia Putri Amelia Putri Amelia Putri Hasria Sri Murni Rafita Ramayanti Rafita Ramayati Rafita Ramayati Ria Puspitasari Ria Puspitasari Ridwan M. D. Rina A.C. Saragih Rina A.C. Saragih, Rina A.C. Rina Amalia C Saragih Rina Amalia C. Saragih Rina Amalia C. Saragih Rina Amalia Karomina Saragih Rina C. Saragih Rismala Dewi Rizki Aryo Wicaksono Rizki Aryo Wicaksono ROSIHAN ANWAR Rosmayanti Siregar Rosmayanti Siregar, Rosmayanti Rusdidjas dr Rusdidjas Rusdidjas Rusdidjas Rusdidjas Saptawati Bardosono Saragih, Rina Amalia Sembiring, Krisnarta Siregar, Gurnal Rai Gandra Siska Mayasari Siti Helmyati Sri Alemina Ginting Sri Sofyani Srie Yanda Sulaiman Yusuf Suryani Ginting Syafruddin Haris Syahril Pasaribu Syahril Pasaribu Syahril Pasaribu Syahril Pasaribu Syahril Pasaribu Syahril Pasaribu Syahril Pasaribu Syamsidah Lubis Syarif, Erlita Wienanda Syilvia Jiero T. Murad El Fuad Taralan Tambunan Tiangsa Sembiring Tjut Dharmawati Tri Faranita Tri Faranita Trina Devina Wahyudi Wahyudi Wijaya, Richo Wisman Dalimunte Wisman Dalimunthe Yanni, Gema Nazri Yanni, Gema Nazri Yoyoh Yusroh Yunnie Trisnawati Yunnie Trisnawati Yunnie Trisnawati Yunnie Trisnawati Yunnie Trisnawati Yunnie Trisnawati Yunnie Trisnawati Zakiudin Munasir

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