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Indhira Alimin
"ABSTRAK
Latar Belakang: Perlunya stratifikasi risiko dan evaluasi terapi berkala pada
sindrom koroner akut (SKA) terkait mortalitas dan morbiditas di kemudian hari.
Petanda biokimia ST2 praktis dan lebih murah, serta tidak dipengaruhi oleh usia,
jenis kelamin dan fungsi ginjal. Kadarnya dapat berbeda antar ras, namun belum
ada data yang menyajikan profil kadar ST2 awal dan penurunan pasca terapi
definitif di Indonesia.
Metode: Studi deskriptif longitudinal pada 40 subjek yang diperiksan kadar ST2
secara ELISA saat awal dan setelah terapi definitif.
Hasil: Didapatkan proporsi kadar ST2 awal <35 ng/mL lebih dominan ( 52,5% vs.
47,5%). Kadar ST2 awal tertinggi didapatkan pada IMA-NST, yaitu 46,79 ng/mL
(kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) yang memiliki awitan terlama
(48 jam). Hipertensi memiliki proporsi tertinggi (91,7%) dan usia berbanding lurus
dengan kadar ST2. Proporsi kadar ST2 yang tidak mengalami penurunan sebesar
30%, terutama APTS (41,7%) dengan usia rerata 3 tahun lebih tua (58 tahun vs. 55
tahun).
Simpulan: Didapatkan kadar ST2 <35 ng/mL pada sebagian besar subjek, tertinggi
pada IMA-NST. Lama awitan, hipertensi dan usia diduga berhubungan dengan
kadar ST2 awal tinggi. Kadar ST2 pasca terapi menurun pada sebagian besar subjek.ABSTRACT
Background: Acute coronary syndrome been a burden for causing high mortality
and morbidity, therefore risk stratification and therapy evaluation are needed. A
new biomarker ST2 is practice and less expensive for daily usage and it also doesn?t
influenced by age, gender, and kidney function. The ST2 value are different in due
to race among countires. There is no data available regarding ST2 baseline and after
definitive treatment profile in Indonesia.
Method: It is a longitudinal descriptive study that conducted prospectively on 40
subjects. The value of ST2 was examined using ELISA methods at baseline and
after definite treatment.
Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs.
47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79
ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had the
longest onset of chest pain (48 hours). Hypertension had the highest proporsion
(91,7%) and age were proportional to the ST2 value. The proportion of the ST2
value that didn?t decreased after therapy were lesser than the decrease (30% vs.
70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 years
old).
Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higher
than ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 level
were found in NSTEMI-ACS. Onset of angina, hypertension and age were found
to be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. ;Background: Acute coronary syndrome been a burden for causing high mortality
and morbidity, therefore risk stratification and therapy evaluation are needed. A
new biomarker ST2 is practice and less expensive for daily usage and it also doesn?t
influenced by age, gender, and kidney function. The ST2 value are different in due
to race among countires. There is no data available regarding ST2 baseline and after
definitive treatment profile in Indonesia.
Method: It is a longitudinal descriptive study that conducted prospectively on 40
subjects. The value of ST2 was examined using ELISA methods at baseline and
after definite treatment.
Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs.
47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79
ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had the
longest onset of chest pain (48 hours). Hypertension had the highest proporsion
(91,7%) and age were proportional to the ST2 value. The proportion of the ST2
value that didn?t decreased after therapy were lesser than the decrease (30% vs.
70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 years
old).
Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higher
than ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 level
were found in NSTEMI-ACS. Onset of angina, hypertension and age were found
to be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. ;Background: Acute coronary syndrome been a burden for causing high mortality
and morbidity, therefore risk stratification and therapy evaluation are needed. A
new biomarker ST2 is practice and less expensive for daily usage and it also doesn?t
influenced by age, gender, and kidney function. The ST2 value are different in due
to race among countires. There is no data available regarding ST2 baseline and after
definitive treatment profile in Indonesia.
Method: It is a longitudinal descriptive study that conducted prospectively on 40
subjects. The value of ST2 was examined using ELISA methods at baseline and
after definite treatment.
Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs.
47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79
ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had the
longest onset of chest pain (48 hours). Hypertension had the highest proporsion
(91,7%) and age were proportional to the ST2 value. The proportion of the ST2
value that didn?t decreased after therapy were lesser than the decrease (30% vs.
70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 years
old).
Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higher
than ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 level
were found in NSTEMI-ACS. Onset of angina, hypertension and age were found
to be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. ;Background: Acute coronary syndrome been a burden for causing high mortality
and morbidity, therefore risk stratification and therapy evaluation are needed. A
new biomarker ST2 is practice and less expensive for daily usage and it also doesn?t
influenced by age, gender, and kidney function. The ST2 value are different in due
to race among countires. There is no data available regarding ST2 baseline and after
definitive treatment profile in Indonesia.
Method: It is a longitudinal descriptive study that conducted prospectively on 40
subjects. The value of ST2 was examined using ELISA methods at baseline and
after definite treatment.
Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs.
47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79
ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had the
longest onset of chest pain (48 hours). Hypertension had the highest proporsion
(91,7%) and age were proportional to the ST2 value. The proportion of the ST2
value that didn?t decreased after therapy were lesser than the decrease (30% vs.
70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 years
old).
Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higher
than ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 level
were found in NSTEMI-ACS. Onset of angina, hypertension and age were found
to be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. "
Lengkap +
Fakultas Kedokteran Universitas Indonesia, 2016
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Novrizal Saiful Basri
"Latar Belakang: Sindrom pascatrombosis (PTS) diestimasikan terjadi pada 20-50% pasien dengan jarak beberapa bulan hingga 1-2 tahun pasca trombosis vena dalam DVT. Insidensi PTS akan lebih tinggi pada DVT yang ditatalaksana konservatif. Tatalaksana DVT pada COVID-19 selama ini hanya konservatif. Sampai saat ini belum ada penelitian mengenai evaluasi terjadinya sindrom pascatrombosis pada pasien DVT dengan COVID- 19.
Metode: Desain penelitian yang digunakan adalah desain desain kohort retrospektif. Penelitian dilakukan di Divisi Bedah Vaskular dan Endovaskular, Departemen Medik Ilmu Bedah, Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo, Jakarta. Waktu penelitian akan berlangsung selama 6 bulan, yaitu dari bulan Desember 2022 sampai dengan Mei 2023. Dilakukan uji bivariat dan multivariat pada data yang didapat.
Hasil: Didapatkan insidensi terjadinya PTS pada pasien DVT dan COVID-19 adalah 59.3%. Variabel yang meningkatkan risiko terjadinya PTS dan secara statistik bermakna menurut uji bivariat adalah riwayat DVT ipsilateral (p = 0.000), lokasi trombus Iliaka Femoral Popliteal (p = 0.000), dan derajat COVID-19 sedang berat (p = 0.000). Dari uji multivariat didapatkan y = -2.965 + 2.545X1(riwayat DVT ipsilateral) + 2.110X2 (lokasi trombus Iliaka Femoral Popliteal) + 2.679X3 (Derajat COVID-19 sedang berat).
Kesimpulan: Insidensi terjadinya PTS pada pasien DVT dengan COVID-19 yang dilakukan terapi konservatif lebih meningkat. Faktor risiko yang memengaruhi terjadinya sindrom pascatrombosis secara uji statistik bivariat bermakna menurut uji bivariat adalah adanya riwayat DVT ipsilateral, lokasi trombus Iliaka Femoral Popliteal, dan derajat COVID-19 sedang berat. Dari uji multivariat didapatkan derajat COVID-19 sedang berat sebagai faktor risiko terbesar PTS sebesar 14.5X, riwayat DVT ipsilateral sebagai faktor risiko terbesar PTS sebesar 12.7X dan lokasi trombus Iliaka Femoral Popliteal sebagai faktor risiko sebesar 8.2x.

Background: Post-thrombotic syndrome (PTS) is estimated to occur in 20-50% patients several months to 1-2 years after DVT. The incidence of PTS will be higher in DVT which is managed conservatively. So far, the management of DVT in COVID-19 has only been conservative. To date, there have been no studies regarding the evaluation of the occurrence of postthrombotic syndrome in DVT patients with COVID-19.
Methods: The design used for this research was a retrospective cohort design. The study was conducted at the Division of Vascular and Endovascular Surgery, Department of Medical Surgery, dr. Cipto Mangunkusumo, Jakarta. The research time will last for 6 months, from December 2022 to May 2023. Bivariate and multivariate tests were carried out.
Results: The incidence of PTS in DVT and COVID-19 patients was 59.3%. Variables that increasing the risk of PTS and were statistically significant according to bivariate tests were history of ipsilateral DVT (p = 0.000), Popliteal Iliac Femoral thrombus location (p = 0.000), and moderate to severe COVID-19 severity (p = 0.000). From the multivariate test, y = -0.596 + 2.545X1 (ipsilateral DVT history) + 2.110X2 (popliteal Iliac Femoral thrombus location) + (-2.679)X3 (moderate to severe COVID-19 severity).
Conclusion: The incidence of PTS in DVT patients with COVID-19 who are undergoing conservative therapy is increasing. The risk factors that influence the occurrence of postthrombotic syndrome in statistically significant bivariate tests are history of ipsilateral DVT, the location of the Iliac Femoral Popliteal thrombus, and the moderate to severe COVID-19 severity. From the multivariate test, moderate to severe COVID-19 severity was found as the biggest risk factor for PTS by 14.5-fold, history of ipsilateral DVT as risk factor for PTS by 12.7-fold and the location of the Iliac Femoral Popliteal thrombus as a risk factor for 8.2-fold.
"
Lengkap +
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Dian Wahyu Tanjungsari
"Sindrom koroner akut (SKA) merupakan salah satu kegawatan kardiovaskular di
Instalasi Gawat Darurat (IGD). Tatalaksana SKA yang ada saat ini membutuhkan waktu
minimal 3 jam untuk menentukan apakah pasien dirawat atau dipulangkan, hal ini akan
berdampak pada kepadatan IGD dan pemborosan biaya perawatan. European Society of
Cardiology merekomendasikan algoritma 0/1 jam pada pasien dengan gambaran EKG
non elevasi segmen ST (NEST) dengan menggunakan high sensitive troponin T (hscTnT)
dalam menegakkan atau penapisan infark miokard akut non elevasi segmen ST
(IMA-NEST). Penelitian ini bertujuan untuk membandingkan nilai diagnostik hs-cTnT
jam ke-1 dan jam ke-3 pada terduga SKA non elevasi segmen ST dengan awitan nyeri
dada kurang dari 6 jam. Desain penelitian potong lintang. Sebanyak 100 subjek
penelitian yang diambil secara konsekutif sampling. Sensitivitas, spesifisitas, nilai
prediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/1 jam secara berurutan
adalah 93,75%, 98,81%, 93,75%, 98,81%, sementara sensitivitas, spesifisitas, nilai
prediksi positif, dan nilai prediksi negatif kadar hs-cTnT 0/3 jam secara berurutan
adalah 87,50%, 96,81%, 93,33% 97,65%. Pemeriksaan hs-cTnT 0/1 jam dapat
dipergunakan dalam rule in dan rule out terduga IMA-NEST dengan awitan nyeri dada
kurang dari 6 jam.

Acute coronary syndrome (ACS) is one of the cardiovascular events in an Emergency
Installation (ED). The patients management of ACS required at least 3 hours to
determined whether the patient hospitalized or outpatient, these would increased EDs
crowded and high cost treatment. The European Society of Cardiology recommended a
0/1 hour algorithm in patients with ECG showed non ST segment elevationusing high
sensitive troponin T (hs-cTnT) parameter to rule in or rule out non ST segment
elevation myocard infarct (NSTEMI).We aimed to compare diagnostic values of hscTnT
at the 1st and 3rd hour in NSTEMI with chest pain onset less than 6 hours. Study
design was cross sectional. A total of 100 subjects enrolled by consecutive sampling
method. Sensitivity, specificity, positive predictive value, and negative predictive value
of hs-cTnT 0/1 hours were 93.75%, 98.81%, 93.75%, 98.81%, while sensitivity,
specificity, positive predictive value, and the negative predictive value of hs-cTnT 0/3
hours were 87.50%, 96.81%, 93.33%, 97.65%. Hs-cTnT 0/1 hour test can be used in
rule in and rule out suspect NSTEMI with the chest pain onset less than 6 hours."
Lengkap +
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T58732
UI - Tesis Membership  Universitas Indonesia Library
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Astuti Giantini
"Sindrom koroner akut (SKA) merupakan masalah kesehatan nasional karena tingginya angka morbiditas dan mortalitas serta beban biaya yang dibutuhkan. Intervensi koroner perkutan (IKP) dan terapi antiplatelet seperti klopidogrel merupakan tata laksana yang direkomendasikan oleh organisasi kardiologi internasional. Meskipun demikian, pasien SKA masih dapat mengalami kejadian kardiovaskular mayor (KKM). Kemungkinan, resistensi klopidogrel berperan pada KKM sedangkan resistensi klopidogrel mungkin dipengaruhi oleh faktor genetik dan epigenetik. Penelitian ini bertujuan untuk mengetahui hubungan faktor genetik yaitu polimorfisme gen CYP2C19 dan P2Y12, serta epigenetik yaitu metilasi DNA gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dengan resistensi klopidogrel dan pengaruhnya terhadap KKM pada pasien SKA pasca IKP.
Untuk menganalisis hubungan faktor genetik dan epigenetik dengan resistensi klopidogrel, penelitian dilakukan dengan desain potong lintang, sedangkan untuk analisis hubungan faktor genetik dan epigenetik dengan KKM dilakukan dengan desain kohort prospektif. Subjek penelitian meliputi 201 pasien SKA pasca IKP dan mendapat terapi klopidogrel di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dari bulan September 2018 sampai dengan Juni 2020. Resistensi klopidogrel ditentukan dengan pemeriksaan light transmission aggregometry (LTA) apabila hasilnya lebih besar dari 59% dengan agonis ADP 20 mM. Deteksi polimorfisme gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dilakukan dengan metode qRT-PCR, sedangkan metilasi DNA gen CYP2C19 dan P2Y12 dikerjakan dengan metode konversi bisulfit. Pasien diobservasi selama satu tahun dan jika ada angina pektoris, infark miokard akut (IMA) rekuren, stroke, atau kematian, dicatat sebagai KKM.
Dari 201 subjek, terdapat 45,8% carrier mutant polimorfisme *2 dan *3 gen CYP2C19, 36,8% carrier mutant polimorfisme rs3679479 gen P2Y12, 10% hipometilasi DNA gen P2Y12, 80,1% hipometilasi DNA gen CYP2C19, dan 66,2% ekspresi miRNA-26a up regulated. Proporsi resisten klopidogrel adalah 49,8% dan proporsi KKM adalah 14,9% (kematian 7,5%). Terdapat hubungan antara merokok (p = 0,001; OR 0,37 [IK 95%; 0,20–0,68]), hipometilasi DNA gen CYP2C19 (p = 0,037; OR 2,13 [IK 95%; 1,04–4,37]), dan ekspresi miRNA-26a up regulated (p = 0,020; OR 2,03 [IK 95%; 1,12–3,68]) dengan resistensi klopidogrel. Terdapat hubungan antara jenis kelamin perempuan (p = 0,040; HR 2,73 [IK 95%; 1,05–7,14]), usia ≥ 60 tahun (p = 0,035; HR 2,17 [IK 95%; 1,06–4,48]), eGFR rendah (p = 0,001; HR 3,29 [IK 95%; 1,59–6,84]), dan polimorfisme *2 dan *3 gen CYP2C19 (p = 0,047; HR 2,12 [IK 95%; 1,01–4,46]) dengan KKM dalam satu tahun.
Hanya faktor epigenetik berupa metilasi DNA gen CYP2C19 dan ekspresi miRNA-26a yang berhubungan dengan resistensi klopidogrel. Walaupun resistensi klopidogrel tidak berhubungan dengan KKM, terdapat hubungan antara faktor genetik polimorfisme *2 dan *3 gen CYP2C19 dengan KKM.

Acute coronary syndrome (ACS) is a national health problem due to high morbidity and mortality, and cost burden as well. Percutaneous coronary intervention (PCI) and antiplatelet therapy such as clopidogrel are recommended. However, ACS patients could still experience major adverse cardiovascular events (MACE). Clopidogrel resistance possibly plays a role in MACE whereas it may be affected by genetic and epigenetic factors. Therefore, the objective of this study was to determine the relationship between genetic factors which are CYP2C19 and P2Y12 polymorphisms, as well as epigenetic factors which are DNA methylation of CYP2C19 and P2Y12, and miRNA-26a expression and their effects on MACE in post-PCI patients.
To analyze the association between genetic and epigenetic factors and clopidogrel resistance, the study design was cross-sectional, while the study design of relationship between genetic and epigenetic factors and MACE was prospective cohort. The subjects were 201 post-PCI ACS patients who received clopidogrel therapy at Harapan Kita Hospital from September 2018 to June 2020. Clopidogrel resistance was determined by light transmission aggregometry (LTA) if the result was greater than 59% with agonist ADP 20 µM. The detection of CYP2C19 and P2Y12 gene polymorphisms and miRNA-26a expression were carried out by qRT-PCR method, while the DNA methylation of the CYP2C19 and P2Y12 genes were carried out by bisulfite conversion method. Patients were observed for one year and angina pectoris, recurrent acute myocardial infarction (AMI), stroke, or death, were recorded as MACE.
From 201 subjects, 45.8% were CYP2C19*2 and CYP2C19*3 polymorphism mutant carrier, 36.8% were rs3679479 P2Y12 polymorphism mutant carrier, 10% were hypomethylated of P2Y12, 80.1% were hypomethylated of CYP2C19, and 66.2% were up regulated in miRNA-26a expression. 49.8% of subjects were clopidogrel resistant and 14.9% of subjects experienced MACE (death was 7.5%). Smoking (p = 0.001; OR 0.37 [CI 95%; 0.20–0.68]), hypomethylated of CYP2C19 (p = 0.037; OR 2.13 [CI 95%; 1.04–4.37]), and up regulated miRNA-26a expression (p = 0.020; OR 2.03 [CI 95%; 1.12–3.68]) were associated with clopidogrel resistance. Female gender (p = 0.040; HR 2.73 [CI 95%; 1.05–7.14]), age over 60 years old (p = 0.035; HR 2.17 [CI 95%; 1.06–4.48]), low eGFR (p = 0.001; HR 3.29 [CI 95%; 1.59–6.84]), and CYP2C19*2 and CYP2C19*3 polymorphisms (p = 0.047; HR 2.12 [CI 95%; 1.01–4.46]) were associated with MACE in one year.
Only DNA methylation of CYP2C19 and miRNA-26a expression were associated with clopidogrel resistance. Although clopidogrel resistance was not associated with MACE, there was association between CYP2C19*2 and CYP2C19*3 polymorphisms and MACE.
"
Lengkap +
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
D-Pdf
UI - Disertasi Membership  Universitas Indonesia Library
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Nita Aprilia
"Berduka dapat dirasakan oleh pasien SKA yang kehilangan kondisi sehatnya secara tiba-tiba. Berduka bisa menjadi rumit sehingga dapat menurunkan kepatuhan pasien terhadap pengobatan dan meningkatkan resiko kejadian infark berulang dan rehospitalisasi. Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan berduka pada pasien yang dirawat pasca SKA. Penelitian ini merupakan penelitian kuantitatif dengan desain deskriptif analitik, menggunakan pendekatan cross sectional yang melibatkan 132 responden. Analisis data menggunakan analisis deskriptif, uji chi square dan regresi logistik berganda. Karakteristik sosiodemografik responden menunjukkan bahwa sebagian besar berjenis kelamin laki-laki, berpendidikan tinggi, aktif bekerja, dan berstatus menikah. Responden dengan usia ≤ 60 tahun dan > 60 tahun memiliki proporsi yang sama. Berdasarkan karakteristik klinis, sebagian besar responden menjalani rawat inap ≤ 5 hari, tidak memiliki riwayat SKA, memiliki ko-morbid, dan memiliki keterbatasan mobilitas fisik. Sebagian besar responden memiliki dukungan keluarga baik, kecerdasan spiritual baik dan persepsi terhadap penyakit negatif. Hasil dari penelitian ini menunjukkan bahwa sebagian besar responden mengalami berduka yang tinggi. Terdapat hubungan yang signifikan antara ko-morbid (p=0.028), keterbatasan mobilitas fisik (p=0.031), kecerdasan spiritual (p=0.022), dan persepsi terhadap penyakit (p=0.004), dimana persepsi terhadap penyakit adalah faktor yang paling dominan berhubungan dengan berduka, dengan OR 3.362 (CI 95% 1.389-8.134). Pentingnya intervensi keperawatan untuk meningkatkan persepsi terhadap penyakit dan mencegah terjadinya berduka tinggi yang memanjang dan rumit pada pasien SKA.

Grief can occur in ACS patients who suddenly lose their healthy condition. Grieving can be complicated and can reduce patient compliance with treatment and increase the risk of recurrent infarction and rehospitalization. This study aims to determine factors associated with grieving among hospitalized patients after ACS event. This research is a quantitative research with a descriptive analytical design, using cross sectional approach involving 132 respondents. Data analysis used descriptive analysis, chi-square test and multiple logistic regression. The sociodemographic characteristics of the respondents showed that the majority were men, highly educated, actively working, and married. Respondents aged ≤ 60 years and > 60 years have the same proportion. In clinical characteristics, most of the respondents were hospitalized for ≤ 5 days, had no history of ACS, had co-morbidities, and had limited physical mobility. Most respondents had good family support, good spiritual intelligence and negative perceptions of illness. The results of this research show that the majority of respondents experienced high levels of griving. There is a significant relationship between co-morbidity (p= 0.028), limited physical mobility (p=0.031), spiritual intelligence (p=0.022) and perception of illness (p=0.004), where perception of the illness is the most dominant factor related to grief, with OR 3.362 (CI 95% 1.389-8.134). It is important to provide nursing interventions to improve perceptions of illness and prevent prolonged and complicated grief in ACS patients."
Lengkap +
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2024
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Rr. Putri Adimukti Ningtias
"Sindrom koroner akut (SKA) berkaitan erat dengan aspek nutrisi. Pencegahan primer dan sekunder dimulai saat diketahui pasien memiliki risiko atau telah mengalami gejala. Permasalahan nutrisi pada SKA dapat menurunkan asupan selama perawatan intensif, terutama pada pasien usia lanjut karena terdapat berbagai komorbid yang dapat menjadi kendala pemberian nutrisi. Risiko malnutrisi selama perawatan di rumah sakit juga dapat terjadi dan akan mempengaruhi luaran klinis. Terapi medik gizi bertujuan mengurangi respons inflamasi, mempertahankan imbang energi dan nitrogen positif, mencegah katabolisme, serta mencegah komplikasi. Serial kasus ini melaporkan empat orang pasien SKA yang dirawat di ruang rawat intensif. Usia pasien antara 51–64 tahun. Status gizi pasien saat admisi berkisar dari berat badan normal hingga obes morbid. Terapi medik gizi yang diberikan menggunakan panduan pada perawatan jantung intensif, sakit kritis, dan panduan lain sesuai kondisi klinis pasien. Pemberian nutrisi ditingkatkan bertahap sesuai kondisi klinis dan toleransi saluran cerna dengan target kebutuhan energi total dan protein tercapai saat persiapan pulang rawat. Mikronutrien yang diberikan adalah vitamin B kompleks dan asam folat. Seluruh pasien pulang dengan perbaikan kondisi klinis. Terapi medik gizi yang adekuat mendukung kesembuhan pasien.

Acute Coronary Syndrome (ACS) is closely related to nutritional aspects. Primary and secondary prevention should be started when the patients are known to be at risk or have experienced the symptoms. Patients with ACS have nutritional problems that can reduce intake during intensive care, particularly in elderly patients, because of various comorbidities that can be nutritional challenges. The risk of malnutrition during hospitalized may also occur and will affect clinical outcomes. Medical therapy in nutrition aims to reduce the inflammatory response, maintain energy and positive nitrogen balance, and prevent catabolism and complications. The patients were 51–64 years old. The nutritional status of patients at admission ranges from normal weight to morbid obesity. Medical therapy in nutrition was given using the guidelines for cardiac intensive care, critical illness, and other guidelines according to the patient's clinical condition. Provision of nutrition was gradually increased according to the clinical and gastrointestinal tolerance with the goal of achieving total energy requirements during discharge planning. The micronutrients given were B-complex vitamins and folic acid. All patients discharged with improvements in clinical conditions. Adequate medical therapy in nutrition supports the patients recovery."
Lengkap +
Depok: Fakultas Kedokteran Universitas Indonesia, 2018
T58574
UI - Tesis Membership  Universitas Indonesia Library
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Nunung Nursyarofah
"Latar Belakang: Respon antar-individu yang bervariasi terhadap obat antiplatelet (clopidogrel) telah dilaporkan. Perbedaan tingkat metabolisme clopidogrel untuk metabolit aktif tiol menggambarkan variabilitas antar-individu dalam penghambatan trombosit. Sitokrom P4502C19 (CYP2C19) memetabolisme zat metabolit aktif tiol. Carier polimorfisme yang menyebabkan hilangnya fungsi CYP2C19 * 2 dan * 3 alel pada terapi antiplatelet mengakibatkan berkurangnya penghambatan agregasi trombosit. Informasi mengenai hubungan antara CYP2C19 * 2 dan * 3 dengan inhibisi agregasi trombosit pada pasien Sindroma koroner akut di Indonesia masih terbatas. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara dua varian, CYP2C19 * 2 (6816>A) dan CYP2C19 * 3 (636G>A) terhadap penurunan fungsi inhibisi agregasi trombosit.
Bahan dan Metode: Desain penelitian cross sectional. Jumlah responden adalah 114 orang (dipilih berdasarkan kriteria inklusi dan kriteria ekslusi). Pemeriksaan polimorfisme CYP2C19 dilakukan dengan menggunakan teknik Real Time-Polymerase Chain Reaction (RT-PCR) TaqMan SNP Genotyping Assays dengan alat dari applied Biosystems 7500 Fast/7900HT Fast Real Time PCR Systems (in standart or 9600 emulation mode). Inhibisi agregasi trombosit diperiksa dengan menggunakan metode Light Transmisi Aggregometry (LTA) dengan alat Helena AggGRAM Analyzer pada penambahan 5umol/L ADP sebagai agregator.
Hasil: Distribusi inhibisi agregasi trombosit menunjukkan perbedaan rerata antara responden non carier polimorfisme dengan responden carier polimorfisme (16,9 CI95%: 12,1-21,6 vs 9,4 CI95%: 2,9 - 15,0). Analisis regresi linier menunjukkan bahwa responden carier polimorfisme memiliki inhibisi agregasi trombosit lebih rendah dibandingkan dengan responden non carier polimorfisme. Analisis regresi logistik menunjukkan bahwa responden carier polimorfisme mempunyai odds untuk merespon kurang baik terhadap clopidogrel sebesar 1,9 kali jika dibandingkan dengan responden yang non carier setelah dikontrol oleh variabel umur dan jenis kelamin, hal tersebut mengindikasikan bahwa carier polimorfisme mempunyai inhibisi yang rendah terhadap agregasi trombosit.
Kesimpulan: Temuan kami membuktikan adanya hubungan antara CYP2C19 * 2 dan * 3 polimorfisme dengan inhibisi agregasi trombosit.

Background: Inter-individual variability in response to antiplatelet drugs (clopidogrel) has been reported. The difference in the extent of metabolism of clopidogrel to its active metabolite tiol is the most plausible mechanism for the observed inter-individual variability in platelet inhibition. The cytochrome P4502C19 (CYP2C19) metabolizes the active metabolite tiol. The carrier polymorphisms of reduced - functions of CYP2C19*2 and *3 allele on antiplatelet therapy showed diminished platelet aggregation inhibition. There is limited information on the association between CYP2C19 *2 and *3 with platelet aggregation inhibition in ACS patients generally in Indonesia Population. The aim of this study was to determine the association between two variants, CYP2C19*2 (6816>A) and CYP2C19*3 (636G>A) reduced function with platelet aggregation inhibition.
Material & Method: a cross sectional study was done with 114 subjects (selected by inclusions and exclusions criteria). The CYP2C19 polymorphisms were genotype using the PCR method with TaqMan SNP Genotyping Assays from applied Bio systems 7500 Fast/7900HT Fast Real Time PCR Systems (in standard or 9600 emulation mode). The platelet aggregation inhibition was tested using Light Transmission Aggregometry (LTA) by Helena AggGRAM Analyzer with 5umol/L ADP as aggregator.
Results: The distribution of platelet inhibition aggregation showed difference between respondents with non-carrier polymorphisms and carrier polymorphisms (16,9 CI95%: 12,1 -21,6 vs 9,4 CI95%: 2,9 - 15,0). The linier regression analysist indicated that the carrier polymorphisms have lowest platelet aggregation inhibition compared with non-carrier polymorphisms. The logistic regression analysis indicated that carrier polymorphisms respondents has 1,9 odds to be low response to clopidogrel if compared with non-carrier polymorphisms respondents after adjusted with age and sex and it is indicated that it has low platelet aggregation inhibition.
Conclusion: Our present findings the evidence of an association between CYP2C19 *2 and *3 polymorphisms and platelet aggregation inhibition.
"
Lengkap +
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2013
T38654
UI - Tesis Membership  Universitas Indonesia Library
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Bhanu
"ABSTRAK
Latar Belakang: Kematian pada Penyakit Jantung Koroner (PJK) terutama akibat
tindakan revaskularisasi yang tertunda atau lesi koroner kompleks yang biasanya
lebih buruk pada populasi pasien PGK. Skor Modified ACEF merupakan sebuah
perangkat yang memiliki peran penting dalam prognosis mortalitas PJK. Skor
mACEF belum pernah digunakan untuk mengevaluasi kompleksitas lesi koroner.
Informasi tersebut berguna dalam menentukan prioritas tindakan angiografi
koroner.
Tujuan: Mendapatkan nilai diagnostik dan titik potong skor mACEF sebagai
prediktor kompleksitas lesi koroner pada pasien PGK stadium 3 dan 4 yang
mengalami sindrom koroner akut (SKA).
Metode: Penelitian ini merupakan uji diagnostik secara retrospektif terhadap 179
subjek PGK stadium 3 dan 4 yang mengalami SKA yang dirawat di ICCU RSCM
tahun 2012 hingga 2014. Analisis titik potong skor mACEF dilakukan dengan
menggunakan Receiver Operating Characteristic (ROC) curves dengan interval
kepercayaan (IK) sebesar 95%. Akurasi diagnostik skor mACEF dinilai dengan
cara menghitung sensitivitas, spesifisitas, RKP, dan RKN.
Hasil: Titik potong skor mACEF yang optimal adalah 2,288 dengan sensitivitas
90,9%, spesifisitas 63,7%, RKP 2,5, RKN 0,14 dan prevalens 55,3%.
Kesimpulan: Titik potong yang optimal skor mACEF pada populasi pasien PGK
stadium 3 dan 4 yang mengalami SKA adalah 2,288. Akurasi diagnostik skor mACEF dinilai baik.ABSTRACT
Background: Cardiovascular disease is one of the main causes of death mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%.
Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%.
Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%.
Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainly
due to delayed revascularization or complex coronary lesions which are usually
worse in CKD patients. Modified ACEF (mACEF) score is well established in
determining cardiovascular mortality of patients undergoing revascularization
therapy and has never been used to evaluate the complexity of coronary lesions
before. mACEF score?s potential as a diagnostic tool needs to be evaluated to help
stratify patients eligible for coronary angiography.
Aim: To evaluate mACEF score?s diagnostic value and cut-off point as a
predictor of coronary lesion complexity in patients with CKD stages 3 and 4 with
ACS.
Methods: This study is a diagnostic test conducted retrospectively involving 179
subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012
to 2014. Cut-off analysis was performed using ROC curve with confidence
intervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed to
generate sensitivity, specificity, LR+, and LR-.
Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of
90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%.
Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively."
Lengkap +
Fakultas Kedokteran Universitas Indonesia, 2016
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Anditha Ratnadhiyani
"ABSTRAK
Nama : Anditha RatnadhiyaniProgram Studi : Magister Ilmu KeperawatanJudul : Pengalaman Wanita Pasca Sindrom Koroner Akut dalam Adaptasi terhadap Perubahan Kemampuan Fungsional Pemulihan pasca sindrom koroner akut mencakup proses adaptasi individu terhadap perubahan kemampuan fungsional. Perkembangan dalam penelitian di bidang kardiovaskular menunjukkan dampak dan prognosis sindrom koroner akut yang lebih buruk pada wanita jika dibanding pria, yang dikaitkan dengan perbedaan dalam persepsi, prediktor klinis, dan status sosioekonomi. Penelitian ini bertujuan untuk mengeksplorasi pengalaman wanita pasca sindrom koroner akut dalam adaptasi terhadap perubahan kemampuan fungsional. Metode kualitatif dengan desain fenomenologi deskriptif digunakan untuk memperoleh gambaran pengalaman sepuluh partisipan dalam penelitian ini. Pengambilan data dilakukan dengan wawancara mendalam, kemudian dilakukan content analysis dengan metode Colaizzi. Teridentifikasi enam tema utama dari penelitian ini yaitu respon ketidaknyamanan setelah mengalami sindrom koroner akut, penurunan kemandirian dan kemampuan melakukan aktivitas sebagai dampak perubahan kondisi fisik, self-adjustment sebagai koping terhadap perubahan kemampuan fisik, revaskularisasi memberikan harapan kesembuhan, pengaruh dukungan terhadap psikologis, dan self-effort untuk memulihkan kemampuan fungsional. Hasil penelitian menunjukkan peran penting faktor psikologis dalam proses adaptasi wanita selama pemulihan, sehingga direkomendasikan peningkatan intervensi yang mendukung psikologis dalam tatalaksana pasien wanita dengan sindrom koroner akut. Kata kunci: adaptasi, kemampuan fungsional, sindrom koroner akut, wanita

ABSTRACT
Name Anditha RatnadhiyaniStudy Program Master of NursingTitle The Experiences of Women after Acute Coronary Syndrome in Adaptation to Functional Ability Changes Adaptation to functional ability changes is part of recovery after Acute Coronary Syndrome ACS . Earlier studies have indicated that women with ACS have worse impact and prognosis. It is associated with perception differences, clinical predictors and socio economy status. The aim of this study is to explore experiences of women after ACS in adaptation to functional ability changes. A qualitative study using phenomenological description design was conducted. Ten women after ACS participated in individual in depth interview. Data were analysed using Colaizzi rsquo s procedural approach. Women rsquo s experiences in adaptation were formulated into six main themes 1 inconvenience response to ACS 2 decrease in autonomy and ability to perform activities as a result of physical changes 3 self adjustment as a mechanism to cope with physical ability changes 4 being recovered by revascularization 5 social support promotes psychological improvement and 6 self efforts to improve functional abilities. This research denotes a major role of psychological factors in women rsquo s adaptation during recovery process. Therefore, developing a psychological based intervention for women after ACS is an important strategy to improve outcomes. Keywords acute coronary syndrome, adaptation, functional ability, women"
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2016
T47065
UI - Tesis Membership  Universitas Indonesia Library
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Simatupang, Satria Mula Habonaran
"Latar belakang. Risiko Venous Thromboembolism (VTE) yang terkait dengan keganasan adalah 4,1 kali lipat lebih besar dibandingkan dengan pasien tanpa keganasan. Pasien keganasan memiliki risiko perdarahan yang lebih besar dengan terapi antikoagulan yang umum digunakan. Inferior Vena Cava Filter (IVCF) telah direkomendasikan sebagai alternatif yang kontroversial.
Tujuan. Untuk menemukan bukti ilmiah tertinggi dalam keamanan, manfaat, dan dampak klinis IVCF untuk mengelola VTE terkait keganasan.
Metode. Sesuai dengan pedoman PRISMA, pada situs berbasis data Cochrane, PubMed, dan ClinicalKey dicari menggunakan kata kunci ("Inferior Vena Cava Filter" or "IVCF") and (“Anticoagulant”) and ("Cancer" or "Malignancy") and ("Venous Thromboembolism" or "VTE" or "Pulmonary Embolism" or "Deep Vein Thrombosis") and ("Safety" or "Benefit" or "Complication" or "Recurrence" or "Survival Rate" or "Mortality"). Artikel-artikel ini ditinjau dan dinilai.
Hasil. Ada 10 artikel yang ditinjau (1.191 partisipan). Komplikasi IVCF yang ditemukan: migrasi filter (0,9%), trombosis vena cava (3,7%), PE berulang (2,8%); fraktur filter (0,9%); dan penetrasi IVCF (0,9%). Tidak ada kematian yang ditemukan pada pasien karena komplikasi karena penyisipan filter (LOE 2). Penyisipan IVCF dapat mengurangi tingkat PE tetapi dengan peningkatan jumlah DVT (DVT: dengan filter vs tanpa filter: 35,7% vs 27,5%; HR 1,52; CI95 % 1,02–2,27; p = 0,042; PE: 6,2% vs. 15,1 %; HR 0,37; 95% CI 0,17–0,79; p = 0,008). Enam studi tidak menemukan peningkatan yang signifikan secara statistik dalam mortalitas terkait PE.
Kesimpulan. IVCF aman dan bermanfaat untuk pengelolaan VTE terkait keganasan, terutama pada pasien dengan kontraindikasi antikoagulan (LOE 2, 3 dan 4).

Background. The risk of venous thromboembolism (VTE) associated with malignancy is 4.1-fold greater compared to patients without malignancy. Malignancy patient have greater risk of bleeding with the commonly used anticoagulant therapy. Inferior Vena Cava Filter (IVCF) have been recommended as an controversial alternative.
Objective. To find the highest evidence in the safety, benefit, and clinical outcome of the IVCF for managing VTE associated with malignancy.
Method. Aligning with PRISMA guidelines, online databases Cochrane, PubMed, ScienceDirect and ClinicalKey were searched using keywords ("Inferior Vena Cava Filter" or "IVCF") and (“Anticoagulant”) and ("Cancer" or "Malignancy") and ("Venous Thromboembolism" or "VTE" or "Pulmonary Embolism" or "Deep Vein Thrombosis") and ("Safety" or "Benefit" or "Complication" or "Recurrence" or "Survival Rate" or "Mortality"). These articles were reviewed and appraised.
Results. There were 10 articles reviewed (1,191 participants). Complication of IVCF found: filter migration (0.9%), vena cava thrombosis (3.7%), recurrent PE (2.8%); filter fracture (0.9%); and IVCF penetration (0.9%). No mortality was found in patients due to complications due to filter insertion (LOE 2). IVCF insertion can reduce PE rates but with an increase in the number of DVT (DVT: with filter vs without filters: 35.7% vs 27.5%; HR 1.52; CI95 % 1.02–2.27; p = 0.042 ; PE: 6.2% vs. 15.1%; HR 0.37; 95% CI 0.17–0.79; p = 0.008). Six studies found no statistically significant increase in PE-related mortality.
Conclusion. IVCF is safe and beneficial for the management of malignancy-associated VTE, especially in patients with contraindications to anticoagulants (LOE 2, 3 and 4).
"
Lengkap +
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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