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Neutrophil lymphocyte ratio and severity of acute kidney injury in septic children Kowita, Nurul Huda; Sovira, Nora; Safri, Mulya; Ismy, Jufitriani; Haris, Syafruddin; Herdata, Heru Noviat; Bakhtiar, Bakhtiar
Paediatrica Indonesiana Vol. 63 No. 6 (2023): November 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.6.2023.492-8

Abstract

Background Acute kidney injury (AKI) in sepsis is associated with an inflammatory process in kidney microcirculation and may increase morbidity and mortality in children. The neutrophil lymphocyte ratio (NLR) is an inflammatory biomarker of the inflammatory process in sepsis. Objective To determine the role of NLR in predicting the severity of AKI and to describe the demographic and laboratory characteristics, as they relate to outcomes of pediatric patients with AKI and sepsis. Methods This cross-sectional study was conducted in the PICU at Dr. Zainoel Abidin General Hospital (RSUDZA), Banda Aceh, Aceh. Medical record data were obtained from critically ill children with sepsis and AKI. Chi-square test was used to compare the proportions of each variable. We also calculated odds ratios to evaluate the AKI severity, PELOD-2 score, and patient outcomes. Spearman's analysis was used to look for a possible correlation between NLR and AKI severity in septic children. Results Seventy-one subjects with sepsis and AKI were included. Subject characteristics were as follows: 63.4% males, 63.4% < 1 year of age, 56.3% with respiratory problems as a primary disease, 38% with AKI injury stage, and 54.9% subjects with PELOD-2 score ?10. There was no significant correlation between AKI severity and mortality (OR 3.04; 95%CI 0.990 to 9.378; P=0.052). Subjects with a PELOD-2 score ?10 had a 47.6 times higher chance of mortality in septic children with AKI compared to those with PELOD-2 scores <10. There was no correlation between NLR and AKI severity (r=0.019; P=0.878). Conclusion There is no correlation between NLR and AKI severity. Sepsis accompanied by AKI may increase the risk of mortality in children. Septic children with more severe AKI tends to be less survive.
Relationship between G protein level with left ventricular systolic function in children with acyanotic heart disease Dimiati, Herlina; Srikandi, Mira; Haypheng, Te; Sovira, Nora; Herdata, Heru N.; Bakhtiar, Bakhtiar; Edward, Eka D.
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.v4i2.531

Abstract

Heart failure is a pediatric emergency caused by the heart's inability to adequately meet the body metabolic needs and the most common cause is congenital heart disease (CHD). The G protein is the most prominent family of membrane-bound protein known to act in major regulatory events of the cardiovascular system, one of which is heart failure. The aim of this study was to determine the level of G protein and its relationship with left ventricular systolic function in children with acyanotic CHD. A cross-sectional study was conducted in Dr. Zaionel Abidin Hospital, Banda Aceh, Indonesia. The patients aged 0 to 18 years and had acyanotic CHD diagnosis by echocardiography were included. Anthropometry measurement was performed according to standard WHO procedures and G protein level was measured using the ELISA method. The Chi-squared test was used to measure the relationship between G protein level and left ventricular systolic function. Out of a total of 38 children with acyanotic CHD, the mean level of G protein was 36.25 ng/mL and the mean of left ventricular systolic function was 73.1%. There was no relationship between G protein and left ventricular systolic function in children with acyanotic CHD. However, further study with a larger sample size and considering other variables are needed to confirm this finding.
Risk factors for acute kidney injury in children with critical illness Chalisah, Lilis; Sovira, Nora; Amna, Eka Yunita; Anidar, Anidar; Haris, Syafruddin; Bakhtiar, Bakhtiar
Paediatrica Indonesiana Vol. 64 No. 5 (2024): September 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.5.2024.398-404

Abstract

Background Acute kidney injury (AKI) is an acute functional kidney disorder that increases morbidity and mortality in children. The mortality rate for critically ill patients accompanied by AKI is quite high and is influenced by the degree of AKI, the severity of the disease, and organ function disorders. Understanding the risk factors of developing AKI in children with critical illness can help prevent AKI. Objective To determine the risk factors for AKI in children with critical illness. Methods This retrospective cohort study included 255 children aged 1 month to 18 years admitted at the pediatric intensive care unit (PICU) of dr. Zainoel Abidin Regional Public Hospital, Banda Aceh, Aceh, from January to December 2022 using medical record data. Bivariate and multivariate analyses were performed. Results Acute kidney injury occurred in 68 (26.7%) patients. Based on pRIFLE criteria, 34 (50%) patients had AKI in the failure stage. Risk factors for AKI in children with critical illness were in descending order of RR: sepsis (RR 14.3; 95%CI 11.68 to 18.66; P=0.000), mechanical ventilation (RR 12.13; 95%CI 8.75 to 15.98; P=0.000), respiratory disorders (RR 2.51; 95%CI 2.06 to 4.02; P=0.003), congenital heart disease (RR 2.08; 95%CI 2.00 to 3.05; P=0.004), CNS disorders (RR 1.24; 95%CI 1.02 to 2.49; P=0.048), nephrotoxic drug use (RR 1.41; 95%CI 1.24 to 3.08; P=0.000), and age 1 month to 5 years (RR 0.072; 95%CI 0.16 to 0.32; P=0.010). Conclusion Sepsis is a risk factor for AKI in children with critical illness, followed by mechanical ventilation use, respiratory disorders, nephrotoxic drug use. Age <5 years is a protective factor.
Treatment duration and dosage of valproic acid and subclinical hypothyroidism incidence in pediatric epilepsy patients Carolina, Infra Yunita; Anidar, Anidar; Andid, Rusdi; Yusuf, Sulaiman; Darussalam, Dora; Sovira, Nora
Paediatrica Indonesiana Vol. 64 No. 6 (2024): November 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.6.2024.469-72

Abstract

Background Epilepsy is a central nervous system disorder characterized by abnormal electrical activity in the brain.1 Prolonged administration of valproic acid at therapeutic doses can disrupt thyroid function, leading to subclinical hypothyroidism. This condition is marked by elevated thyroid stimulating hormone (TSH) levels, with normal serum free T4 (FT4) levels.2 Objective To investigate for possible associations between valproic acid therapy duration and dosage with the incidence of subclinical hypothyroidism in pediatric epilepsy patients. Methods This analytical, cross-sectional study included children aged 4 months to 18 years treated at the Pediatric Clinic of RSUD Dr. Zainoel Abidin, Banda Aceh, from September to November 2023. Subjects diagnosed with epilepsy and treated with valproic acid for at least 3 months were included in this study and underwent FT4 and TSH examinations. Results Forty-four children met the study criteria. Subclinical hypothyroidism occurred in 5 (11.4%) subjects during valproic acid therapy. Chi-square analysis revealed no significant association between therapy duration ?1 year (OR 1.286; 95%CI 0.193 to 8.568; P=1.00) or therapy dose ?20-40 mg/kg/day (OR 3.429; 95%CI 0.351 to 33.518; P=0.37) with subclinical hypothyroidism incidence. Conclusion Neither the duration nor the dosage of valproic acid therapy were significantly associated with the incidence of subclinical hypothyroidism in children with epilepsy.
Role of Vitamin D and E as Antioxidants Against Cerebral Endothelial Dysfunction: An In Vivo Study in White Rats (Rattus norvegicus) Sepsis Model Fajri, Fauzan; Fajar, Sukmawan; Hasan, Denny Irmawati; Dimiati, Herlina; Amna, Eka Yunita; Sovira, Nora; Anidar, Anidar; Safri, Mulya; Gunawan, Aris
Journal of Basic Medical Veterinary Vol. 13 No. 2 (2024): Journal of Basic Medical Veterinary, December 2024
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jbmv.v13i2.61610

Abstract

Sepsis is a life-threatening condition caused by the body's response to an infection, leading to organ dysfunction. A antioxidants can help neutralize harmful free radicals that cause cellular and tissue damage through oxidative stress. Vitamin D and E are two antioxidants that have been extensively studied for their potential effectiveness. This study aims to evaluate the effectiveness of vitamins D and E in reducing oxidative stress in the cerebral vascular endothelial cells of Wistar mice in a sepsis model. The study follows an experimental design and uses a posttest with a control group. The levels of NO and SOD in 24 sepsis model mice were measured using ELISA, and the cerebral endothelial tissues were examined histopathologically. An ANOVA test was performed, followed by the Post Hoc LSD test. NO and SOD levels decreased in sepsis rats from 66.88 ± 16.59 to 88.77 ± 12.83µmol/L. Sepsis mice given vitamin D and E showed significant results on changes in NO and SOD levels (p<0.05). Based on the histopathological results of necrosis, inflammation, and hemorrhagic cell damage in sepsis rats reached over 50% of the field of view, significantly different from sepsis mice that had been given vitamin D and E. Sepsis mice were given vitamin D and E influenced 96.2% and 98.7% on changes in NO, SOD, and cerebral endothelial dysfunction (p<0.05). These findings imply that vitamins D and E may be beneficial in managing sepsis-induced cerebral endothelial dysfunction, potentially impacting the treatment and outcomes of sepsis patients.
Urinary neutrophil gelatinase-associated lipocalin to predict acute kidney injury in children with critical illness Fajri, Rizky; Sovira, Nora; Haris, Syafruddin; Dimiati, Herlina; Bakhtiar, Bakhtiar; Amna, Eka Yunita
Paediatrica Indonesiana Vol. 65 No. 1 (2025): January 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.1.2025.47-53

Abstract

Background Acute kidney injury (AKI) can increase mortality in children with critical illness. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker for early prediction of AKI in children. Objective To determine the diagnostic value of uNGAL as a predictor of AKI in children with critical illness. Methods This observational cross-sectional study was conducted in the Emergency Room, Pediatric Intensive Care Unit, and Pediatric Ward of Zainoel Abidin Public Hospital, Banda Aceh, Indonesia, between August and December 2023. Subjects were 40 children aged 1 month to 18 years with critical illness. uNGAL levels were measured on the first day of admission. Blood urea and creatinine levels were measured on the first and third days of admission. We calculated the diagnostic sensitivity and specificity of uNGAL to predict AKI. The optimal uNGAL cut-off point for this purpose was determined using receiver operating characteristic (ROC) curve analysis. Result In the majority of patients (29/40; 72.5%) critical illness occurred at the ages of 5 to 18 years. The most common primary diseases were central nervous system disorders in 14/40 (35%) patients, gastrointestinal infection in 6/40 (15%) patients, and malignancy in 5/40 (12.5) patients. Median uNGAL levels were significantly elevated in subjects with renal impairment [17.37 (range 6.13-29.70) ng/mL] compared to those with normal renal function [4.87 (range 0.32-29.49) ng/mL] (P=0.0001). The optimal uNGAL cut-off point was >9.99 ng/mL, with an AUC of 0.842, 81% sensitivity, and 78.9% specificity to predict AKI. The OR of AKI in children with uNGAL levels >9.99 ng/mL was 10.66 (95%CI 2.30 to 49.30; P=0.003). Conclusion Urinary neutrophil gelatinase-associated lipocalin (uNGAL) can be used as a predictor of acute kidney injury in children with critical illness.
Risk factors of mortality in children with acquired prothrombin complex deficiency at Dr. Zainoel Abidin General Hospital,Banda Aceh Munawarah, Syifa; Sovira, Nora; Anidar, Anidar; Herdata, Heru Noviat; Edward, Eka Destianti; Ismy, Jufitriani
Paediatrica Indonesiana Vol. 65 No. 3 (2025): May 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.3.2025.253-9

Abstract

Background  Acquired prothrombin complex deficiency (APCD) is a rare but life-threatening bleeding disorder in children. Intracranial hemorrhage (ICH) is the leading cause of death, with an estimated risk affecting 50–80% of cases. Key risk factors associated with mortality in APCD include onset of disease, presence of ICH, and the initial Glasgow Coma Scale (GCS) score. Routine intramuscular administration of vitamin K at birth has been shown to effectively prevent early and late-onset vitamin K deficiency bleeding. However, in settings where vitamin K prophylaxis is not administered or is delayed, the risk of APCD increases significantly. Despite these concerns, other potentially relevant clinical factors contributing to APCD outcomes remain under-investigated. Objective To identify risk factors associated with APCD mortality in children treated at Dr. Zainoel Abidin General Hospital, Banda Aceh. Methods This cross sectional study analyzing children diagnosed with APCD at Dr. Zainoel Abidin General Hospital from October 2022 to October 2024. Data were collected from the medical records of 30 children and analyzed using Chi-square and logistic regression tests. Results This study included 30 subjects, the majority of whom were male and aged 8 days to 6 months. Most of subject were born full term, delivered vaginally, and had birth weight ≥ 2.500 grams. Notably, 25/30 children did not receive vitamin K prophylaxis, 14/18 children were exclusively breastfed without vitamin K prophylaxis, and 25/30 children had good nutritional status. Late-onset APCD was observed in 14 out of 30 cases.  Intracranial vs extracranial hemorrhage was occurred in 21 vs 9 children. Initial GCS scores ≤ 8 at initiation of treatment were noted in 11/30 children. The mortality rate was occurred in 12/30 subjects (40%). Chi-square analysis revealed significant associations between increased mortality and late onset APCD (P=0.030), ICH (P=0.049), and initial GCS score ≤ 8 (P=0.009). Logistic regression analysis revealed initial GCS score was associated with the highest risk of mortality in APCD, with a 16-fold increase in risk (P=0.022; OR 15.9; 95%CI 1.5 to 168.9). Conclusion Intracranial hemorrhage, late-onset APCD, and initial GCS scores ≤ 8 are significantly associated with increased APCD mortality, with initial GCS emerging as the most influential risk factor.
Faktor Risiko Mortalitas Anak dengan Sepsis dan Disseminated Intravascular Coagulation: Peran Penanda Inflamasi dan Koagulasi di Rumah Sakit Zainoel Abidin Banda Aceh Nuriyanto, Alivia Rizky; Edward, Eka Destianti; Andid, Rusdi; Sovira, Nora; Herdata, Heru Noviat; Thaib, Teuku Muhammad
Sari Pediatri Vol 27, No 1 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp27.1.2025.9-17

Abstract

Latar belakang. Sepsis yang tidak tertangani dapat berlanjut menjadi Disseminated Intravascular Coagulation (DIC). Apabila DIC tidak segera ditangani dapat menimbulkan kegagalan organ dan meningkatkan mortalitas. Memahami pemeriksaan penanda inflamasi dan faktor koagulasi memegang peranan penting dalam prognosis dan upaya mencegah mortalitas pada anak dengan sepsis dan DIC. Tujuan. Untuk mengetahui faktor risiko mortalitas berdasarkan penanda inflamasi dan faktor koagulasi pada anak dengan sepsis disertai DIC di RSUD dr. Zainoel Abidin Banda Aceh.Metode. Penelitian ini merupakan studi observasional analitik dengan pendekatan cross-sectional pada anak usia 1 bulan sampai 18 tahun di ruang rawat inap dan Pediatric Intensive Care Unit (PICU) RSUD dr. Zainoel Abidin Banda Aceh sejak Januari sampai Desember 2023 dengan menggunakan data rekam medis 104 anak yang memenuhi kriteria penelitian. Analisa data Bivariat menggunakan uji chi-square dan uji fisher serta uji regresi logistik untuk data multivariat.Hasil. Insiden sepsis dan DIC pada anak sebanyak 104 subjek dengan kelompok meninggal paling banyak dijumpai pada kelompok usia <5 tahun, jenis kelamin perempuan, gangguan respirasi, ? 2 komorbid, lama rawatan yang lebih lama, skor PELOD-2 yang lebih dari 13, skor ISTH yang lebih dari 5, gizi baik dan penggunaan ventilasi mekanik. Faktor risiko mortalitas berdasarkan penanda inflamasi dan faktor koagulasi pada anak dengan sepsis dan DIC adalah Neutrofil to Lymphocyte Ratio (NLR) (p < 0,001) dengan OR 16,16 (IK95%: 4,43-154,42), leukosit (p=0,006) dengan OR 9,05 (IK95%: 1,83-43,79), D-dimer (p=0,006) dengan OR 6,25 (IK95%: 1,67-23,39) dan trombosit (p=0,026) OR 0,22 (IK95%: 0,06-0,835).Kesimpulan. Nilai NLR merupakan faktor risiko mortalitas pada anak dengan sepsis dan DIC.
Role of vitamin C in reducing cardiovascular oxidative stress: An in vivo study using sepsis rat models Raihani, Rifa; Sovira, Nora; Andid, Rusdi; Yusuf, Sulaiman; Safri, Mulya; Dimiati, Herlina; Fajri, Fauzan; Sentosa, Sukmawan F.; Hasan, Denny I.
Narra X Vol. 3 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narrax.v3i1.179

Abstract

The aim of this study was to evaluate the effect of vitamin C on reducing cardiovascular oxidative stress in sepsis rat models. An experimental animal study with a post-test control group design was conducted at the Laboratory of Animal Research, Faculty of Veterinary Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia, from September to December 2023, using 18 male Wistar strain rats (Rattus norvegicus). Rats were divided into three groups: control (Group K), lipopolysaccharide 5 mg/kg body weight (BW) (Group L), and lipopolysaccharide 5 mg/kg BW with oral vitamin C (18 mg/day) (Group LC). Rats were euthanized after two weeks with ketamine (15–20 mg/kg intraperitoneally) and cervical dislocation. Blood samples (3 mL) and heart organs were collected. Nitric oxide (NO) levels were measured through enzyme-linked immunosorbent assay (ELISA), and cardiac muscle cells were observed using an Olympus CX21 microscope.  The LC group exhibited a significantly lower mean endothelial dysfunction score than the L group (p<0.001), although no significant difference in NO levels was observed between L and LC groups (p=0.262), indicating that vitamin C did not significantly affect NO levels. This suggests that the improvement in endothelial function observed in the LC group may be mediated through mechanisms other than NO modulation. The MANOVA test revealed that vitamin C administration accounted for 84.8% of changes in endothelial function in the sepsis rat model (p<0.001). In conclusion, vitamin C confers a protective effect against severe cardiac and endothelial damage, as evidenced by the amelioration of necrosis, inflammatory cell infiltration, congestion, and vacuolization caused by lipopolysaccharide.
Central obesity and its association with metabolic syndrome in adolescent students of Aceh Sport High School: A cross-sectional study Nadia, Nurul; Dimiati, Herlina; Amna, Eka Yunita; Andid, Rusdi; Sovira, Nora; Thaib, T.M.
AcTion: Aceh Nutrition Journal Vol 10, No 2 (2025): June
Publisher : Department of Nutrition at the Health Polytechnic of Aceh, Ministry of Health

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30867/action.v10i2.2485

Abstract

Obesity remains a significant nutritional issue in the pediatric population and is closely linked to metabolic disorders. According to the World Health Organization (2022), 160 million individuals aged 5–19 years are classified as obese.  This study aimed to evaluate the association between central obesity and metabolic syndrome (MetS) in sports students. This cross-sectional study was conducted at Aceh Sports High School from May to August 2024, involving 43 students selected through simple random sampling. Although the sample size was relatively small, these findings offer valuable preliminary insights. The data collected included demographics, anthropometric measurements, blood pressure, and blood tests (glucose, HDL cholesterol, and triglycerides). Central obesity was assessed using waist circumference and MS was evaluated based on the NCEP ATP III criteria. Data were analyzed descriptively, followed by the chi-square test. The majority of the participants were not at risk of MS (51,2%). However, chi-square analysis revealed a statistically significant association between waist circumference and MetS (p<0,001, OR = 3,75 95% CI = 2,072– 6,788). In conclusion, while most participants were not at risk of MetS, central obesity emerged as a strong predictor. These findings underscore the need for early screening and intervention, even in physically active adolescents.