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"Angka kematian pada pasien dengan infark miokardium akut (IMA) telah menurun secara signifikan oleh karena strategi terapi reperfusi saat ini. Terapi reperfusi dapat berakibat pada cedera reperfusi. Oleh karena itu, tatalaksana pada pasien ini menghadapi tantangan baru dalam hal diagnosis dan tatalaksana gagal jantung, identifikasi kondisi iskemia, estimasi keperluan antikoagulan, dan penilaian risiko kardiovaskular secara menyeluruh. Ilustrasi kasus ini akan menunjukkan pengaruh magnetic resonance imaging (MRI) kardiak dalam penilaian patofisiologi IMA pada era terapi reperfusi. MRI kardiak akan memberikan informasi berguna yang akan membantu para klinisi dalam tatalaksana dan pemilihan strategi terapi spesifik pada pasien IMA.

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AbstractMortality in patients with acute myocardial infarction (AMI) has decreased significantly and appears to be the result of current reperfusion therapeutic strategies. Reperfusion itself may develop into reperfusion injury. Therefore, management of these patients poses several challenges, such as diagnosing and managing heart failure, identifying persistent or inducible ischaemia, estimating the need for anticoagulation, and assessing overall cardiovascular risk. This case presentation will demonstrate the impact of cardiac magnetic resonance imaging (MRI) in the assessment of the pathophysiology of AMI inthe current reperfusion era. Cardiac MRI can provide a wide range of clinically useful information which will help clinicians to manage and choose specific therapeutic strategies for AMI patients."

"Recent advances in MR technology permit the application of diffusion MRI outside of the brain. In this book, the authors present cases drawn from daily clinical practice to illustrate the role of diffusion sequences, along with other morphological and functional MRI information, in the work-up of a variety of frequently encountered oncological and non-oncological diseases. Breast, musculoskeletal, whole-body, and other applications are covered in detail, with careful explanation of the pros and cons of diffusion MRI in each circumstance. Quantification and post-processing are discussed, and advice is provided on how to acquire state of the art images, and avoid artifacts, when using 1.5- and 3-T magnets. Applications likely to emerge in the near future, such as for screening, are also reviewed. The practical approach adopted by the authors, combined with the wealth of high-quality illustrations."

"Therapeutic hypothermia has emerged as a very important treatment option for patients with cardiac arrest as it provides significant protection from developing neurologic injury once the patient has been successfully resuscitated. Studies have demonstrated over 15% absolute risk reduction in death and neurologic injury using this therapy. Although hospitals and medical centers have become familiar with this important intervention it still remains greatly under utilized due to an experience and lack of resources to safely and effectively deploy such a program. The objective of this book is to educate and familiarize both providers and institutions as to how to develop and deploy and provide therapeutic hypothermia to their patients. The current knowledge for this is provided by speakers and national experts and also by literature review. There are several courses being provided on this as well throughout the US. These are good venues for people to come and see and get hands on experience, but there still needs to be a concrete book with references on how to go about getting this program started."

"ABSTRAKLatar Belakang. Kejang merupakan gejala yang sering ditemukan pada tumor primer intrakranial dan penyebab utama morbiditas terhadap pasien.Pemeriksaan EEG diperlukan untuk menentukan kesesuaian antara fokus kejang dengan lokasi tumor pada MRI yang akan menentukan prognosis kejang serta banyak faktor-faktor yang mempengaruhi kesesuaian antara fokus kejang dengan lokasi tumor. Belum adanya data mengenai kejang pada tumor primer intrakranial serta kesesuaian berdasarkan gambaran EEG dan MRI menjadi dasar dilakukannya penelitian ini. Tujuan.Mengetahui kesesuaian antara aktivitas epileptiform pada EEG dan lesi tumor dengan MRI pada pasien tumor primer intrakranial dengan klinis kejang. Metode.Desain penelitian berupa studi potong lintang (cross sectional).Subyek penelitian adalah semua pasien dengan tumor primer intrakranial yang ada di ruang rawat inap dan rawat jalan neurologi, bedah saraf, radiologi RS Cipto Mangunkusumo yang sudah dilakukan EEG dan MRI.Ditentukan aktivitas epileptiform dan dianalisa kesesuaiannya dengan lokasi tumor berdasarkan MRI. Hasil.Dari 33 subyek dengan tumor primer intrakranial dengan klinis kejang , didapatkan hanya 17 subyek yang menunjukkan aktivitas epileptiform (51,5%), perempuan lebih banyak dari lelaki, dengan rerata usia adalah 34 tahun. Sebagian besar mengalami kejang parsial dan secondary generalized seizure(SGS) merupakan tipe kejang parsial terbanyak (16 dari 17 subyek). Kejang sering ditemukan pada tumor di frontal (11 dari 17 subyek) dan pada jenis tumor primer Low grade(8 dari 17 subyek). Kesesuaian aktivitas epileptiform dengan lokasi tumor didapatkan pada 8 dari 17 subyek dengan lebih banyak yang sesuai pada lobus temporal. Kesimpulan.Dari seluruh pasien tersangka tumor primer intrakranial dengan klinis kejang hanya didapatkan 8 dari 17 subyek yang sesuai antara aktivitas epileptiform pada EEG dengan lesi tumor pada MRI.Gambaran aktivitas epileptiform pada EEG tidak dipengaruhi oleh usia, bentuk bangkitan kejang, jenis tumor, lokasi berdasarkan lobus, lokasi berdasarkan parenkim otak, durasi sakit, dan ukuran tumor.

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ABSTRATBackground.Seizures are a common symptom in primary intracranial tumors and a major cause of morbidity to the patient. EEG examination is necessary to determine the suitability of the seizure focus to the location of the tumor on MRI that will determine the prognosis of seizures as well as a lot of factors that affect compatibility between focal seizures with tumor location. The absence of data on seizures in primary intracranial tumors and suitability based on EEG and MRI picture is the basis of this study. Purpose.Knowing the correspondence between epileptiform activity on EEG and MRI tumor lesions in patients with primary intracranial tumors with clinical seizures. Method.Design research is a cross-sectional study (cross-sectional). Subjects were all patients with primary intracranial tumors that exist in the inpatient and outpatient neurology, neurosurgery, radiology Cipto Mangunkusumo already done EEG and MRI. Epileptiform activity determined and analyzed for compliance with the location of the tumor by MRI. Result. From 33 subjects with primary brain tumors with clinical seizures, obtained only 17 subjects demonstrated epileptiform activity (51.5%), more women than men, with a mean age was 34 years. Most had partial seizures and secondary generalized seizures (SGS) is a type of partial seizure majority (16 of 17 subjects). Seizures are often found in tumors in the frontal (11 of 17 subjects) and the type of primary tumor Low grade (8 of 17 subjects). Suitability of epileptiform activity by tumor location obtained in 8 of 17 subjects with more appropriate in the temporal lobe. Conclusion.From all patients suspected of primary brain tumors with clinical seizures obtained only 8 of the 17 subjects that fit between epileptiform activity on EEG with tumor lesions on MRI. Picture of epileptiform activity on EEG was not influenced by age, shape seizures, tumor type, location based lobes, based on the location of the brain parenchyma, duration of illness, and tumor size."

"ABSTRACTBackground: there are currently three iron chelator readily available for patients Indonesia; deferiprone/DFP (branded as Ferriprox), deferasirox/DFX (branded as Exjade) and deferoxamine/DFO (branded as Desferal). This study aims to determine which iron chelator is the most efficient in reducing cardiac and hepatic iron overload (measured by means of T2 MRI). Methods: journal search with determined MeSH term was done in PubMed and Scopus. Studies that looked upon thalassemia major patient in all ages with usage of monotherapy iron chelation and its effect on myocardial T2 MRI and/or liver T2 MRI was included. Appraisal of studies was done using Oxford CEBM appraisal tools and Joanna Brigs Institute critical appraisal tools. Results: total of 11 studies with grand total of 611 samples were included. Mean T2 MRI value or (when available) mean changes in T2 MRI value after usage of specific iron chelator was gained from all the studies included. Comparison study and individual studies shows better control and increase of myocardial T2 MRI in those with DFP, and of liver T2 in those with good adherence to DFO chelation. Conclusion: DFP is superior in controlling or reducing myocardial iron load (as proven by mT2 MRI) and DFO had better capabilities in controlling or reducing hepatic iron load (as proven by liver T2* MRI). Studies with longer observation and larger samples is needed to see a significant changes of T2 MRI in DFX."

"ABSTRAK Latar belakang: Kardiomiopati akibat kelebihan besi masih merupakan penyebab kematian utama pada pasien thalassemia b mayor. Kardiomipati akibat kelebihan besi merupakan penyakit yang reversibel dengan pemberian kelasi besi yang ditandai dengan gejala awal gangguan diastolik. Amino-terminal pro-brain natriuretic peptide NT-proBNP merupakan biomarker yang sensitif dalam mendeteksi disfungsi diastolik.Tujuan: Mengevaluasi nilai diagnostik NT-proBNP dalam mendeteksi hemosiderosis jantung yang dinilai dengan MRI T2 jantung.Metode: Enam puluh delapan pasien dengan thalassemia b mayor usia 10-18 tahun tanpa gejala gagal jantung menjalani pemeriksaan NT-proBNP saat sebelum transfusi darah. Semua subyek diperiksa MRI T2 Jantung dalam kurun waktu maksimal 3 bulan median 19 hari . Pasien kemudian dibagi menjadi kelompok hemosiderosis jantung MRI T2 jantung 20 ms .Hasil: Dari 68 pasien, didapatkan rasio lelaki : perempuan sebesar 1: 1,1 dengan usia median 14,1 tahun rentang : 10-17,8 tahun . Kadar NT-proBNP tidak berbeda bermakna antara kelompok hemosiderosis jantung dan tidak hemosiderosis jantung p-0,233 . Uji diagnosis NT-proBNP dengan nilai titik potong 160 pg/mL menghasilkan nilai sensitivitas, spesifisitas, nilai duga postif, dan nilai duga negatif secara berurutan sebesar 38,46 , 58,1 , 17,8 , dan 50 .Simpulan: Pengukuran NT-proBNP tidak dapat digunakan untuk mendeteksi hemosiderosis jantung pada anak. ABSTRACT Background Iron induced cardiomyopathy remains the leading cause of mortality in patients with thalassemia b major. Iron deposition related cardiomiopathy, which may be reversible through iron chelation, is characterized by early diastolic dysnfunction. Amino terminal pro brain natriuretic peptide NT proBNP is a sensitive biomarker of diastolic dysfunction.Aim To evaluate the diagnostic value of NT proBNP as a surrogate marker of iron overload examined with MRI T2 .Methods sixty eight b thalassemia major patients 10 18 years with no signs of heart failure underwent NT proBNP measurement before routine transfusion. All subjects were prospectively performed cardiac MRI T2 examination within three months median 19 days . Patients were divided as cardiac hemosiderosis cardiac MRI T2 20 ms Result Of 68 patients, the male to female ratio was 1 1,1 and the median age was 14.1 years range 10 17.8 years . NT proBNP levels were not different between hemosiderosis and non hemosiderosis p 0,233 . Diagnosis test using cut off value of 160 pg mL resulted in sensitivity of 38.46 , specificity of 58.1 , positive predictive value of 17.8 , and negative predictive value of 50 .Conclusion NT proBNP cannot be used to detect cardiac hemosiderosis in adolescent."

"Pendahuluan: Optimalisasi pelayanan resusitasi dapat dipadupadankan dengan teknologi yang berkembang saat ini, salah satunya adalah aplikasi seluler yang dapat diterapkan dengan mudah dalam sistem pelayanan resusitasi. Cardiac Arrest Resuscitation Mobile Application (CARMA) merupakan alat bantu dalam ACLS yang digunakan untuk membantu para praktisi dalam melakukan tindakan resusitasi. Penggunaan aplikasi dapat dimulai pada pelatihan berbasis simulasi. Metode: Penelitian ini adalah uji klinis acak pada simulasi henti jantung dengan menggunakan manekin fidelitas tinggi. Simulasi dengan durasi dua belas menit dan berupa lima rangkaian ritme. Sejumlah 26 kelompok mahasiswa kedokteran dibagi kedalam dua kelompok, yaitu kelompok menggunakan aplikasi dan standar. Tujuan utama penelitian adalah untuk membandingkan kepatuhan panduan klinis pada kedua kelompok. Penilaian kepatuhan berdasarkan persentase pemenuhan daftar tilik yang sudah tervalidasi dan sudah dilakukan uji realibilitas sebelumnya. Tujuan sekunder untuk menilai kualitas kompresi dada dan waktu pemberian epinefrin. Hasil: Terdapat perbedaan bermakna kepatuhan panduan klinis pada kelompok aplikasi dibandingkan dengan kelompok standar (88,95 ± 6,86 vs 73,98 ± 6,40, p < 0,001). Variabel yang tidak menunjukkan perbedaan bermakna pada penelitian ini antara lain adalah kedalaman kompresi dada dan interval waktu pemberian epinefrin.Simpulan: Penggunaan aplikasi seluler dapat meningkatkan kepatuhan panduan klinis pada simulasi kasus henti jantung.

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Background: The optimization of resuscitation services can be aligned with current technological advancements, including mobile applications that can be easily implemented in resuscitation services. The Cardiac Arrest Resuscitation Mobile Application (CARMA) is a tool in Advanced Cardiovascular Life Support (ACLS) designed to assist practitioners in performing resuscitation actions. The application's use can commence in simulation-based training.

Methods: This study is a randomized clinical trial on cardiac arrest simulation using a high-fidelity mannequin. The simulation lasted twelve minutes and included five rhythm sequences. Twenty-six groups of medical students were divided into two groups: one using the application and the other following standard procedures. The main objective of the study was to compare compliance with clinical guidelines in both groups. Compliance assessment was based on the percentage of validated checklist items, previously subjected to reliability testing. Secondary objectives included evaluating chest compression quality and epinephrine administration time. Results: There was a significant difference in compliance with clinical guidelines between the application group and the standard group (88.95 ± 6.86 vs. 73.98 ± 6.40, p < 0.001). Variables such as chest compression depth and epinephrine administration interval did not show significant differences in this study. Conclusion: The use of mobile applications can enhance compliance with clinical guidelines in cardiac arrest simulation cases."