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"ABSTRAKLatar belakang dan Tujuan : Varises esofagus merupakan komplikasi sirosis hati dengan mortalitas tertinggi. Pemeriksaan USG Doppler yang bersifat non invasif, tersedia luas dan relatif murah, dipertimbangkan sebagai metode skrining, namun belum ditemukan parameter Doppler splenoportal yang dapat digunakan sebagai indikator varises dengan akurat. Indeks volume aliran vena lienalis terhadap kecepatan aliran vena porta dipikirkan dapat menjadi parameter baru yang akurat.Metode : Studi observasional potong lintang dilakukan pada 28 pasien sirosis hati di Divisi Hepatologi Departemen Ilmu Penyakit Dalam Rumah Sakit Cipto Mangunkusumo dalam kurun waktu November 2015 hingga Februari 2016. Indeks dan parameter Doppler lainnya merupakan data primer. Subjek dibagi menjadi tiga kelompok, yakni kelompok non varises, varises kecil dan besar. Uji komparatif dilakukan untuk membandingkan indeks dan parameter Doppler lainnya diantara ketiga kelompok tersebut. Analisis kurva receiver operating characteristic (ROC) dilakukan pada parameter yang secara statistik bermakna untuk mendapatkan nilai sensitifitas dan spesifisitasnya.Hasil : Nilai tengah indeks pada kelompok non varises 9,60 (4,67 – 15,07), varises kecil 21,18 (8,92 – 25,24) dan varises besar 64,43 (46,67 – 145,88) dengan nilai p<0,001. Pada analisis kurva ROC didapatkan titik potong indeks 15,78 dengan sensitifitas 80% dan spesifisitas 100% untuk membedakan kelompok varises kecil dan non varises, serta titik potong 36,0 dengan sensitifitas dan spesifisitas 100% untuk membedakan kelompok varises besar dan kecil.Kesimpulan : Terdapat hubungan yang bermakna antara indeks volume aliran vena lienalis terhadap kecepatan aliran vena porta secara ultrasonografi dengan derajat varises esofagus secara endoskopi pada pasien sirosis hati dan indeks tersebut dapat digunakan sebagai indikator varises esofagus dengan akurasi tinggi.

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ABSTRACTBackground and Objective : Esophageal varices is a complication of liver cirrhosis with high mortality. Doppler ultrasound examination is non-invasive, widely available and relatively low cost to be considered as a screening method of varices. Unfortunately, there is still no splenoportal Doppler parameter that can be used as an indicator of varices with high accuracy. Index of splenic vein flow volume to portal vein flow velocity is thought to be a new, more accurate parameter.Methods : A cross-sectional observational study conducted in 28 patients with liver cirrhosis in the Division of Hepatology Department of Internal Medicine Cipto Mangunkusumo Hospital during November 2015 to February 2016. Index and other splenoportal Doppler parameters are the primary data. Subjects were divided into three groups : a group of non varices, small and large varices. The comparative test conducted to compare the mean index and other splenoportal Doppler parameters among the three groups. Analysis of receiver operating characteristic (ROC) curve was performed on parameters that are statistically significant to get the sensitivity and specificity value.Results : Median index in the group of non varices is 9,60 (4,67 – 15,07), 21,18 (8,92 – 25,24) in small varices and 64,43 (46,67 – 145,88) in large varices group with p<0.001. ROC curve analysis generated optimal cutting point index 15,78 which gives 80% sensitivity and 100% specificity to differentiate small and non varices group and the cutoff point of 36.0 which provides 100% sensitivity and specificity to differentiate among the large and small varices.Conclusions : There is a significant association between the index of splenic vein flow volume to portal vein flow velocity by ultrasound with the degree of esophageal varices by endoscopy in patients with liver cirrhosis and this index can be used as indicator of esophageal varices with high accuracy."

"Latar Belakang: Sarkopenia dan malnutrisi merupakan komplikasi sirosis hati dekompensata yang berhubungan dengan luaran klinis yang buruk. Varises esofagus (VE) merupakan luaran klinis yang paling sering ditemui pada pasien sirosis hati dekompensata. Hubungan komplikasi Varises Esofagus risiko tinggi dengan kejadian sarkopenia dan malnutrisi belum banyak dilakukan di Indonesia.Tujuan : mengetahui hubungan antara sarkopenia dan malnutrisi terhadap luaran komplikasi VE risiko tinggi pada pasien sirosis hati.Metode: Studi observasional cross-sectional dilakukan pada 155 pasien di RS Cipto Mangunkusumo pada Januari hingga September 2023. Sarkopenia didefinisikan sebagai kehilangan massa dan kekuatan otot dan atau menurunnya performa fisik sesuai dengan kriteria AWGS 2019 (Asian Working Group for Sarcopenia). Kriteria malnutrisi menggunakan GLIM (Global Leadership Initiative on Malnutrition). Analisis multivariat dilakukan menggunakan regresi logistik.Hasil: Total 155 pasien sirosis hati, 48 pasien memiliki VE risiko tinggi dan 107 pasien memiliki VE risiko rendah. Prevalensi sarkopenia pada pasien sirosis hati ditemukan sebesar 42,6%, sementara prevalensi malnutrisi ditemukan sebesar 82,6%. Kombinasi koeksistensi sarkopenia dan malnutrisi ditemukan sebesar 42,6%. Status sarkopenia berhubungan secara statistik dengan kejadian VE risiko tinggi setelah dikontrol dengan variabel Child Pugh (Adjusted PR: 1,62 (IK 95%: 1,01-2,59; p=0,04). Sementara itu tidak ditemukan hubungan yang bermakna antara malnutrisi dengan kejadian VE risiko tinggi. Pada evaluasi kombinasi koeksistensi dua faktor risiko sarkopenia dan malnutrisi, ditemukan hubungan yang bermakna terhadap kejadian VE risiko tinggi.Kesimpulan: Terdapat hubungan signifikan antara sarkopenia terhadap VE risiko tinggi. Selain itu, adanya koeksistensi sarkopenia dan malnutrisi sebagai faktor risiko gabungan secara statistik signifikan dalam kejadian VE risiko tinggi.

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Background: Sarcopenia and malnutrition are complications of decompensated liver cirrhosiswhich is associated with poor clinical outcomes. Esophageal varices (VE) are the most common clinical outcome in patients with decompensated liver cirrhosis.The relationship between high-risk complications of esophageal varices and the incidence of sarcopenia and malnutrition has not been widely studied in Indonesia.

Objective :determine the relationship between sarcopenia and malnutrition on the outcome of high-risk VE complications in liver cirrhosis patients.

Method: Cross-sectional observational study was conducted on 155 patients at Cipto Mangunkusumo Hospital from January to September 2023. Sarcopenia is defined as loss of muscle mass and strength and/or decreased physical performance according to the 2019 AWGS (Asian Working Group for Sarcopenia) criteria. Malnutrition criteria use GLIM (Global Leadership Initiative on Malnutrition). Multivariate analysis was performed using logistic regression.

Results:A total of 155 patients with liver cirrhosis, 48 patients had high risk VE and 107 patients had low risk VE. The prevalence of sarcopenia in liver cirrhosis patients was found to be 42.6%, while the prevalence of malnutrition was found to be 82.6%. The combined coexistence of sarcopenia and malnutrition was found to be 42.6%. Sarcopenia status was statistically related to the incidence of high risk VE after controlling for the Child Pugh variable (Adjusted PR: 1.62 (95% CI: 1.01-2.59; p=0.04). Meanwhile, no significant relationship was found between malnutrition and the incidence of high risk VE. In evaluating the combination of the coexistence of two risk factors for sarcopenia and malnutrition, a significant relationship was found with the incidence of high risk VE. Conclusion:There is a significant relationship between sarcopenia and high risk VE. In addition, the coexistence of sarcopenia and malnutrition as combined risk factors was statistically significant in the occurrence of high-risk VE."

"Latar belakang: Pasien dengan tumor muskuloskeletal (MSK) ganas menunjukkan insidens deep vein thrombosis (DVT) bervariasi. USG Doppler berwarna merupakan modalitas terpilih untuk evaluasi DVT. Tujuan: Menilai hubungan trombus, kecepatan aliran, dan ketebalan dinding vena pada USG Doppler berwarna vena profunda ekstremitas bawah pada pasien dengan tumor primer MSK ganas. Metode: Penelitian ini menggunakan data primer dari pemeriksaan USG Doppler berwarna vena profunda ekstremitas bawah, yaitu trombus, ketebalan dinding vena, dan kecepatan aliran vena, serta data sekunder, yaitu ukuran tumor dari magnetic resonance imaging (MRI) atau computed tomography >(CT) scan dan durasi gejala tumor dari rekam medis. Penelitian dilakukan di Departemen Radiologi dan Poliklinik Orthopaedi dan Traumatologi Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM) bulan Agustus 2020 hingga Maret 2022. Hasil: Terdapat 10% insidens trombus pada sistem vena profunda ekstremitas bawah pada 30 subyek dengan tumor primer MSK ganas. Subyek dengan trombus cenderung memiliki volume tumor lebih besar dibandingkan tanpa trombus, namun secara statistik tidak bermakna. Kesimpulan: Dimensi dan volume tumor pada subyek dengan trombus cenderung lebih besar dibandingkan tanpa trombus. Pada penderita tumor MSK ganas, dapat ditemukan gambaran klinis dan laboratoris yang menyerupai DVT namun belum tentu didapatkan trombus, sehingga USG Doppler berwarna penting untuk membedakan ada tidaknya DVT.

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Background: Patients with malignant musculoskeletal (MSK) tumors show variable incidence of deep vein thrombosis (DVT). Color Doppler ultrasound (CDUS) is the modality of choice for DVT evaluation.

Objective: To assess the relationship of thrombus, flow velocity, and venous wall thickness on CDUS of lower extremities deep veins in patients with primary malignant MSK tumors.

Methods: Primary data from CDUS of lower extremities deep vein, including thrombus, venous wall thickness, and venous flow velocity. Tumor size was taken from magnetic resonance imaging (MRI) or computed tomography (CT) scans. Duration of tumor symptoms was taken from medical records. The study was conducted at the Department of Radiology and the Orthopaedi and Traumatology Polyclinic of the Cipto Mangunkusumo National General Hospital (RSUPNCM) from August 2020 to March 2022.

Results: There was 10% incidence of thrombus in 30 subjects. Subjects with thrombus tended to have larger tumor volume but it was not statistically significant.

Conclusion: Tumor dimensions and volume in subjects with thrombus tend to be larger than those without thrombus. In patients with malignant MSK tumors, clinical and laboratory features that resemble DVT can be found, but not necessarily a thrombus, therefore CDUS is important for distinguishing the presence or absence of DVT."

"Penyakit Ginjal Kronik (PGK) merupakan kelainan struktur atau fungsi ginjal yang mengalami penurunan selama 3 bulan yang mengalami peningkatan prevalensi kasus. Peningkatan prevalensi kejadian PGK juga akan meningkatkan kebutuhan hemodialisis dan penggunaan arteriovenous fistula (AVF). Maturasi dan keberhasilan AVF dipengaruhi oleh faktor pasien dan struktur vaskular. Latihan isometrik dilaporkan dapat meningkatkan diameter vena, arteri, dan peak systolic velocity (PSV). Tujuan penelitian ini untuk melihat pengaruh latihan isometrik pre operatif terhadap diameter vena cephalica, diameter arteri radialis, PSV, intimal medial thickening (IMT), dan volume flow arteri radialis. Desain penelitian adalah eksperimental pre and post-test study, dilakukan di RSUPN Cipto Mangunkusumo. Penelitian dilaksanakan follow up pasien selama 8 minggu latihan isometri. Total subjek penelitian sebanyak 38 orang. Usia median subjek penelitian yaitu 56 tahun dengan rentang usia 20 sampai 71 tahun. Terdapat perbedaan yang signifikan antara diameter vena (p=0,003), PSV (p=0,032), dan volume flow (p=0,030) subjek penelitian pre dan post latihan isometrik. Terdapat perbedaan signifikan antara perubahan diameter vena terhadap komorbid diabetes melitus. Tidak terdapat perbedaan bermakna antara perubahan diameter vena, PSV, dan volume flow paska latihan ismoetrik terhadap kelompok usia, komorbid, dan jenis kelamin (p>0,005). Penggunaan latihan isometrik dapat meningkatkan perubahan diameter vena, PSV dan volume flow pada pasien sebelum pembuatan AVF radiocephalica. Tidak terdapat perubahan signifikan diameter vena pasca latihan isometrik pada penderita diabetes melitus.

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Chronic Kidney Disease (CKD) is a disorder of kidney structure or function that has decreased over 3 months and has an increased prevalence of cases. The increasing prevalence of CKD will also increase the need for hemodialysis and the use of arteriovenous fistula (AVF). AVF maturation and success are influenced by patient factors and vascular structure. Isometric exercise is reported to increase the diameter of veins, arteries, and peak systolic velocity (PSV). Objective: Analyzing the effect of preoperative isometric exercise on the diameter of veins, arteries, PSV, intimal medial thickening (IMT), and volume flow. The research design was an experimental pre and post-test study, conducted at Cipto Mangunkusumo Center National Hospital. The study was conducted to follow up patients for 8 weeks of isometric exercise. The total study subjects were 38 people, with the highest prevalence being men, and comorbid hypertension. The median age of the research subjects was 56 years with an age range of 20 to 71 years. There were significant differences between venous diameter (p=0.003), PSV (p=0.032), and volume flow (p=0.030) in pre and post isometric training subjects. There was significant difference between cephalic vein diameter to diabetes mellitus group. There was no significant difference between changes in radial artery diameter, PSV, IMT, and post-isometric exercise volume flow for the age, comorbid, and sex groups (p>0.005). The use of isometric exercises can increase changes in venous diameter, PSV and volume flow in patients before the making of radiocephalic AVF. There was no significant change in venous diameter after isometric exercise in patient with diabetes mellitus.

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Latar Belakang :

Jumlah kasus Pasien dengan Penyakit Ginjal Tahap Akhir (PGTA) terus meningkat, dan permintaan akan hemodialisis juga semakin melonjak. Arteriovenosa Fistula (AVF) menjadi pilihan utama dalam prosedur hemodialisis dan sering ditempatkan sedistal mungkin, namun tingkat keberhasilan cenderung rendah karena ukuran diameter yang tidak optimal. Latihan isometrik dan terapi Far Infrared (FIR) berpotensi untuk meningkatkan diameter, Peak Sistolyc Velocity (PSV), Volume flow arteri Radialis, serta diameter vena Cephalica pada pasien PGTA yang akan menjalani pembuatan AVF radiocephalica.

Tujuan Penelitian ini bertujuan untuk mengidentifikasi korelasi antara pemberian Terapi Far Infra-Red dan latihan isometrik terhadap diameter, PSV, dan aliran volume arteri radialis serta diameter vena cephalica pada pasien-pasien dengan penyakit ginjal tahap akhir yang akan menjalani pembuatan AVF Radiocephalica.

Metode penelitian dilakukan dengan rancangan penelitian eksperimental RCT (Randomized Controlled Trial) di ruang hemodialisis RSUPN Ciptomangunkusumo. Selama 4 minggu, kelompok eksperimen diberikan latihan isometrik dan terapi FIR, dan hasilnya kemudian dibandingkan dengan kelompok kontrol yang hanya diberikan Latihan isometrik

Hasil: Jumlah total subjek penelitian adalah 46 orang, dengan mayoritas perempuan (65,2%) dan komorbiditas Diabetes Melitus (37%). Median usia subjek adalah 54 tahun dengan rentang usia antara 18 hingga 73 tahun. Tersingkap adanya perbedaan signifikan secara statistik antara diameter arteri radialis (p<0.05), PSV arteri radialis (p<0,05), Volume Flow arteri radialis (p<0,05), dan diameter vena cephalica (p<0,05) pada subjek penelitian sebelum dan setelah menjalani latihan isometrik dan Terapi Far Infrared (FIR). Faktor risiko Diabetes Melitus (p<0,05) dan obesitas (p<0,05) juga terbukti memiliki pengaruh signifikan terhadap diameter vena cephalica.

Kesimpulan: Dapat disimpulkan bahwa aplikasi latihan isometrik dan Terapi Far Infrared (FIR) efektif dalam meningkatkan parameter-parameter seperti diameter arteri radialis, PSV arteri radialis, volume flow arteri radialis, serta diameter vena cephalica pada pasien dengan Penyakit Ginjal Tahap Akhir sebelum prosedur pembuatan AVF radiocephalica.

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Background :The number of patients with End Stage Kidney Disease (ESKD) continues to increase, and the need for hemodialysis is also increasing. Arterivenosa Fistula (AVF) is the main access option for hemodialysis and is performed as distally as possible, but the success rate is not very high due to the diameter that is not optimal. The utilization of isometric exercise in conjunction with Far Infrared (FIR) therapy is potentially more effective in enhancing the diameter, Peak Systolic Velocity (PSV), Volume Flow of the Radial Artery, and the cephalic vein diameter in ESKD patients before the creation of radiocephalic AVF compared to using isometric exercise alone.

 

Objective: To determine the difference between isometric exercises combined with Far Infrared therapy and isometric exercise alone on the diameter, Peak Systolic Velocity (PSV), and volume flow of the radial artery, as well as the cephalic vein diameter in End-Stage Kidney Disease patients before radiocephalic AVF creation, compared to utilizing only isometric exercises as the standard procedure..

 

Methods: This study is an RCT (Randomized Controlled Trial) experimental study, conducted in the hemodialysis room of Ciptomangunkusumo Hospital. The study was conducted for 4 weeks of isometric exercise and FIR therapy, the results were compared with the control.

 

Results: The total study subjects were 46 people, mostly female (65.2%), comorbid Diabetes mellitus (37%). Median age was 54 years with a range of 18-73 years. There were statistically significant differences between radial artery diameter (p<0.05), radial artery PSV (p<0.001), radial artery flow volume (p<0.001), cephalic vein diameter (p<0.001) pre and post isometric exercise and FIR. Risk factors of diabetes mellitus (p <0.05) and obesity (p <0.05) have a significant change on the diameter of the cephalic vein.

 

Conclusion: The use of isometric exercise and FIR can increase radial artery diameter, radial artery PSV, radial artery flow volume and cephalica vein diameter in ESKD  patients before radiocephalica AVF creation.

 

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"Latar Belakang: Penyakit ginjal kronis (PGK) atau chronic kidney disease (CKD) didefinisikan sebagai adanya kerusakan ginjal atau perkiraan laju filtrasi glomerolus (LFG) kurang dari 60ml/menit/1,73m2 yang berlangsung selama 3 bulan atau lebih. Tindakan akses vaskular berupa arteriovenous fistula dapat dibuat pada pasien penyakit ginjal kronis yang menjalankan terapi hemodialisis. Latihan isometrik berupa handgrip exercise dilaporkan dapat meningkatkan diameter arteri radialis dan vena cephalica, peak systolic velocity (PSV), intima media thickness (IMT), dan volume flow arteri radialis (RAVF).Tujuan: Menganalisis pengaruh handgrip exercise sebelum dan setelah tindakan pembuatan Arteriovenous Fistula Radiocephalica terhadap perubahan diameter arteri radialis dan vena cephalica, PSV, IMT, dan RAVF.Metode: Desain pada penelitian ini adalah controlled trial yang dilakukan di RSUPN Cipto Mangunkusumo. Setelah tindakan pembuatan Arteriovenous Fistula Radiocephalica, pasien dibagi menjadi dua kelompok, yaitu kelompok kontrol dan kelompok intervensi. Pada kelompok kontrol, pasien melakukan tatalaksana standar sedangkan pada kelompok intervensi, pasien melakukan tatalaksana standar dan handgrip exercise lalu kedua kelompok di follow up setelah 8 minggu.Hasil: Total subjek penelitian sebanyak 53 orang, dimana terdapat 7 pasien yang masuk kriteria drop out, yang terdiri dari 2 pasien meninggal dan 5 pasien tidak kontrol. Usia median pada kelompok intervensi adalah 53 tahun dan pada kelompok kontrol adalah 56 tahun. Pada kelompok yang melakukan handgrip exercise, terdapat perbedaan bermakna antara sebelum dan sesudah latihan yaitu pada parameter diameter arteri radialis (p=0,022), diameter vena cephalica (p<0,001), PSV (p<0,001), dan volume flow arteri radialis (p<0,001). Di sisi lain, tidak terdapat perbedaan bermakna antara nilai IMT sebelum dan sesudah latihan hand grip (p=0,575). Sementara itu, pada kelompok kontrol ditemukan juga terdapat perbedaan signifikan antara sebelum dan sesudah masa follow-up terkait parameter diameter vena cephalica (p<0,001), PSV (p<0,001), dan RAVF (p<0,001). Pada parameter diameter arteri radialis (p=0,103) dan IMT (p=0,083) tidak terdapat perbedaan yang bermakna pada kelompok kontrol.Simpulan: Handgrip exercise dapat meningkatkan perubahan diameter arteri radialis dan vena cephalica, PSV, dan RAVF. Tidak terdapat perubahan pada IMT setelah handgrip exercise.

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Background: Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60ml/min per 1.73 square meters, persisting for 3 monts or more. Creating vascular access such as arteriovenous fistula can be done in hemodialysis therapy patients with chronic kidney disease. Isometric exercises in the form of handgrip exercise has been reported to increase the diameter of radial artery and cephalic vein, peak systolic velocity (PSV), intima media thickness (IMT), and radial artery volume flow (RAVF).

Objective: To analyze the effect of handgrip exercise before and after radiochepalic arteriovenous fistula creation on changes of the diameter of radial artery and cephalic vein, PSV, IMT, and radial artery volume flow.

Methods: The design of this research was controlled trial at Cipto Mangunkusumo Center National Hospital. After the creation of radiocephalic arteriovenous fistula, patients divided into two groups, control group and intervention group. The control group received usual care. Usual care and handgrip exercise was performed in the intervention group, both groups were assessed at 8 weeks post the creation of radiocephalic arteriovenous fistula.

Results: For 53 patients, 7 patients were dropped out, consist of 2 patients passed away and 5 patients lose control. Median age of this research subjects was 56 years old. A significant increase of diameter of radial artery (p=0,022) and cephalic vein (p<0,001), PSV (p<0,001), and radial artery volume flow (p<0,001) was observed in intervention group. Meanwhile there was no change of intima media thickness before and after handgrip exercise (p=0,575). Similarly, there was significant increase of cephalic vein diameter (p<0,001), PSV (p<0,001), and RAVF (p<0,001) and there was no significant change of radial artery diameter (p=0,103) and IMT in control group.

Conclusion: Handgrip exercise improved diameter of radial artery and cephalic vein PSV, and RAVF. There was no change of IMT after handgrip exercise

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"Pendahuluan: Sirosis hati merupakan penyebab mortalitas dan morbiditas global, terutama melalui komplikasi hipertensi porta yang menyebabkan perdarahan varises esofagus (VE). Pasien yang pernah mengalami perdarahan pertama memiliki tingkat kejadian perdarahan berulang yang tinggi dengan angka survival yang rendah. Meskipun endoskopi dapat memprediksi perdarahan berulang, pendekatan ini mahal dan bersifat invasif. Oleh karena itu, pemeriksaan non invasif lain dengan tingkat akurasi yang tinggi perlu dipelajari.Tujuan: Penelitian ini bertujuan untuk mengidentifikasi prediktor non-invasif perdarahan berulang VE (kekakuan hati, kekakuan limpa, skor Child Pugh, dan jumlah trombosit) pada pasien sirosis hati.Metode: Sebanyak 102 sampel pasien sirosis hati yang mengalami riwayat perdarahan VE. Variabel prediktor dalam memprediksi kejadian perdarahan berulang varises esofagus pada penelitian ini meliputi kekakuan hati, kekakuan limpa, skor Child Pugh, serta jumlah trombosit. Analisa multivariat dan uji skor dengan validasi internal untuk mendapatkan model performa terbaik sebagai prediktor perdarahan VE berulang.Hasil: Hasil menunjukkan bahwa kekakuan hati, kekakuan limpa, skor Child Pugh, dan trombositopenia signifikan sebagai prediktor perdarahan berulang VE. Dengan menggabungkan variabel ini, model prediksi dihasilkan dengan AUC 0,870. Diperoleh uji skor dengan validasi bahwa keempat variabel tersebut signifikan sebagai faktor yang berhubungan dengan perdarahan berulang varises esofagus. Kesimpulan: kombinasi kekakuan hati, kekakuan limpa, skor Child Pugh, dan jumlah trombosit memiliki performa baik dalam memprediksi risiko perdarahan varises esofagus berulang pada pasien sirosis hati.

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Background: Liver cirrhosis is a global cause of mortality and morbidity, especially through complications of portal hypertension which causes esophageal variceal (VE) bleeding. Patients who have experienced a first bleed have a high rate of recurrent bleeding with a low survival rate. Although endoscopy can predict recurrent bleeding, this approach is expensive and invasive. Therefore, other non- invasive examinations with a high accuracy need to be researched.

Objective: This study aims to identify non-invasive predictors of recurrent VE bleeding (liver stiffness, spleen stiffness, Child Pugh score, and platelet count) in liver cirrhosis patients.

Methods: A total of 102 samples of liver cirrhosis patients who had a history of VE bleeding were included in this study. Predictor variables in predicting the incidence of recurrent esophageal variceal bleeding in this study include liver stiffness, spleen stiffness, Child Pugh score, and platelet count. Multivariate analysis and internal validity test were used to obtain the best performance model as a predictor of recurrent VE bleeding.

Results: The results showed that liver stiffness, spleen stiffness, Child Pugh score, and thrombocytopenia were significant as predictors of recurrent VE bleeding. By combining these variables, a prediction model was generated with an AUC of 0.870. Validity test of these four variables were significant as factors associated with recurrent esophageal variceal bleeding.

Conclusion: The combination of liver stiffness, spleen stiffness, Child Pugh score, and platelet count has good performance in predicting the risk of recurrent esophageal variceal bleeding in patients with liver cirrhosis."

"Hiperglikemia dan gangguan metabolisme pada diabetes melitus (DM) berhubungan dengan komplikasi penyakit arteri perifer (PAP). Pada pasien DM dengan PAP, disbiosis mikrobiota usus mengakibatkan penurunan produksi short-chain fatty acid (SCFA) sehingga memicu inflamasi nonspesifik dan aterogenesis. Penelitian ini bertujuan untuk mengidentifikasi hubungan kadar SCFA feses dengan berbagai parameter pemeriksaan vaskular pada pasien DM dengan PAP.Metode: Penelitian ini adalah studi potong lintang yang mengidentifikasi hubungan SCFA total, asetat, propionat, butirat, dan valerat feses dengan ankle-brachial index (ABI), toe pressure, diameter, plak, peak systolic velocity (PSV), volume flow (VF), spektrum aliran, dan derajat PAP arteri ekstremitas bawah pada pasien DM dengan PAP di sebuah sentra pelayanan kesehatan tunggal.Hasil: Sebanyak 37 subjek DM dengan PAP dianalisis. Terdapat hubungan negatif bermakna antara nilai asetat absolut dan diameter arteri femoralis communis (CFA) (r = -0,4; p =0,016) serta nilai propionat relatif dengan diameter arteri dorsalis pedis (DPA) (r =-0,376; p =0,04). Terdapat hubungan positif bermakna nilai asetat relatif dengan diameter DPA (r =0,381; p =0,038) serta nilai valerat relatif dengan PSV CFA (r =0,364; p = 0,029). Kelompok dengan plak CFA memiliki nilai asetat absolut yang lebih tinggi (p =0,039) dibandingkan kelompok yang tidak memiliki plak aterosklerotik. Kelompok dengan plak arteri poplitea (POPA) memiliki nilai butirat absolut yang lebih tinggi (p =0,046) dan nilai SCFA total yang lebih tinggi (p =0,046) dibandingkan kelompok yang tidak memiliki plak. Tidak terdapat hubungan bermakna SCFA dengan ABI, volume flow, dan derajat PAP.Kesimpulan: Nilai SCFA feses yang lebih tinggi cenderung berhubungan dengan diameter arteri perifer ekstremitas bawah yang lebih kecil dan PSV yang lebih tinggi. Nilai SCFA feses yang lebih tinggi juga cenderung didapatkan pada kelompok dengan plak arteri di atas lutut. Perlu dilakukan penelitian lanjutan untuk mengevaluasi efek sebab-akibat antara SCFA dan parameter-parameter vaskular pada pasien DM.

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Chronic hyperglycemia and metabolic abnormalities in diabetes mellitus are associated with peripheral arterial disease (PAD). Additionally, in diabetics with PAD, gut microbiota dysbiosis may lead to reduction in short-chain fatty acid (SCFA) production, prompting nonspecific inflammation and atherogenesis. This study aims to identify the association between SCFA and various vascular clinical and laboratory parameters in patients with diabetes and PAD.

Methods: This cross-sectional epidemiological study aims to identify the association of fecal total SCFA, acetate, propionate, butyrate, and valerate on ankle-brachial index (ABI), toe pressure, diameter, atherosclerotic plaque, peak systolic velocity (PSV), volume flow (VF), flow profile, and the degree of PAD of the lower extremity arteries in patients with diabetes and PAD in a single center.

Results: A total of 37 subjects with diabetes and PAD were analyzed. There were negative correlations of absolute acetate levels with common femoral artery (CFA) diameter (r = -0,4; p =0,016) and relative propionate levels with dorsal pedal artery (DPA) diameter (r =-0,376; p =0,04). There were positive correlations of relative acetate levels with DPA diameter (r =0,381; p =0,038) and relative valerate levels with PSV CFA (r =0,364; p = 0,029). Higher absolute acetate levels were found in group with CFA plaques (p =0,039). Higher absolute butyrate levels were found in group with popliteal artery (POPA) plaques (p =0,046), as was higher total SCFA levels (p =0,046). No significant association was found between SCFA and ABI, volume flow, and the degree of PAD.

Conclusion: Higher fecal SCFA levels were associated with smaller vascular diameters and higher PSV in lower extremity arteries. Higher SCFA levels were also more likely to be found in groups with above-knee atherosclerotic plaques. Further research is warranted to confirm the cause-effect relationship between SCFA and various vascular parameters in patients with diabetes and PAD."

"Latar Belakang: Pecahnya varises esofagus (EV) tetap menjadi salah satu komplikasi sirosis yang paling parah. Sebagai gold standard untuk memprediksi kecelakaan ini, Esophagogastroduodenoscopy (EGD) sendiri juga memiliki kelemahan. Tidak semua pasien nyaman dan mau menerima modalitas ini dalam praktik klinis terlepas dari risiko dan beban biaya. Oleh karena itu, pencarian modalitas noninvasif lain yang nyaman tetapi dengan akurasi tinggi masih perlu dipelajari. Diantaranya, Pengukuran Kekakuan Limpa (SSM), Pengukuran Kekakuan Hati (LSM), dan skor Aspartate Amino Transferase to Platelet Ratio Index (APRI) menjadi populer dan dipelajari secara intensif di banyak pusat dengan akurasi yang baik, tetapi hasilnya tetap bertentangan di beberapa penelitian.

Tujuan : Mengetahui kinerja skor SSM, LSM, APRI, dan kombinasinya untuk memprediksi EV pada pasien sirosis hati.

Metode : Sebanyak 141 pasien sirosis hati yang menjalani endoskopi, SSM, LSM, dan perhitungan skor APRI antara Januari 2023 dan Maret 2023. Analisa diagnostik dinilai menggunakan area di bawah kurva penerima-operator (AUC) untuk mengukur dan membandingkan kinerja setiap pengukuran dan kombinasi untuk memprediksi EV dan untuk mendapatkan nilai prediksi optimal yang sesuai. Pengukuran elastografi transien (TE) dilakukan menggunakan fibroscan khusus limpa dengan probe 100 hz.

 

Hasil : Dari 141 pasien, etiologi terbanyak adalah hepatitis B sebanyak 71 pasien (50,4%). Varises esofagus ditemukan pada 116 pasien (86,3%). Dengan menggunakan area under receiver, SSM pada titik potong 40,1 kPa memiliki kinerja terbaik untuk memprediksi EV pada sirosis dengan AUC 0,892 (sensitivitas 88,79%, spesifisitas 80%), diikuti oleh LSM pada titik potong  10,2 kPa dengan AUC 0,832 (sensitivitas 90,52%, spesifisitas 60%), dan skor APRI pada titik potong 0,72 memiliki AUC terendah antara lain 0,780 (sensitivitas 77,59%, spesifisitas 80%). Kombinasi ketiga pemerikssan tidak menunjukkan performa yang lebih baik dibandingkan SSM secara tunggal dengan AUC 0,892.

 

Kesimpulan : SSM memberikan kinerja yang lebih baik daripada skor LSM dan APRI untuk memprediksi EV.

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Background: Esophageal varices (EV) rupture remains one of the most severe complications of cirrhosis. As a gold standard to predict this accident, Esophagogastroduodenoscopy (EGD) itself also has a weakness. Not all patients are convenient and willing to accept this modality in clinical practice apart from the risk and cost burden. Hence, the search for other noninvasive modalities that are convenient but with high accuracy is still noteworthy to be studied. Among them, Spleen Stiffness Measurement (SSM), Liver Stiffness Measurement (LSM), and the Aspartate Amino Transferase to Platelet Ratio Index (APRI) score become popular and intensively studied in many centers with good accuracy, but the results remain conflicting in some studies.

 

Objective: To investigate the performance of SSM, LSM, APRI score, and their combination for predicting EV in liver cirrhosis patients.

 

Methods: A total of 141 patients with liver cirrhosis who had undergone endoscopy, SSM, LSM, and APRI score calculation between January 2023 and March 2023 were enrolled. Diagnostic applicability was assessed by the area under the receiver-operator curve (AUC) to measure and compare the performance of each measurement and combination for predicting EV and to obtain the corresponding optimal prediction value. Transient elastography (TE) measurement was done using spleen-dedicated fibroscan with a 100 Hz probe.

 

Results: Of the 141 patients, the most common etiology was hepatitis B 71 patients (50,4%). Esophageal varices were found in 116 patients (86,3%). Using area under receiver, SSM at cut-off 40,1 kPa had the best performance for predicting EV in cirrhosis with AUC 0,892 (sensitivity 88,79%, specificity 80%), followed by LSM at cut-off 10,2 kPa with AUC 0,832 (sensitivity 90,52%, specificity 60%), and APRI score at cut-off 0,72 had the lowest AUC among others 0,780 (sensitivity 77,59%, specificity 80%). The combination of all measurement tools did not show better performance than SSM alone with AUC 0,892.

 

Conclusion: SSM provides better performance than LSM and APRI score for predicting EV"

"[ABSTRAKLatar belakang. Abnormalitas fungsi vena terkait inflamasi dan hipertensi vena merupakan dasar patofisiologi insufisiensi vena kronik. Pembuktian hubungan faktor inflamasi lokal pada jaringan vena dengan fungsional vena menjadi penting ketika vena yang diteliti akan menjadi konduit vena pada Bedah Pintas Arteri Koroner (BPAK) dan evaluasi patensinya berpengaruh pada mortalitas dan morbiditas pasien Penyakit Jantung Koroner (PJK).Metode. Penelitian ini merupakan studi potong lintang dari 35 sampel jaringan vena saphena magna pasien PJK yang diambil untuk konduit vena pada BPAK dan telah diperiksa IVK menggunakan Duplex Ultrasound (DUS) dengan parameter time refluks, periode bulan September sampai November 2014 di Pusat Jantung Nasional Harapan Kita. Untuk analisa hitung jumlah leukosit dilakukan pewarnaan Hematoxyllin eosin pada jaringan vena oleh ahli patologi anatomi. Analisis statistik dilakukan untuk mencari hubungan antara hitung jumlah leukosit jaringan vena dengan time refluks vena saphena magna.Hasil. Analisa statistik dengan Chi square didapatkan perbedaan bermakna peningkatan jumlah leukosit jaringan vena pada pasien insufisiensi vena kronik dibandingkan normal (52,63 % vs 18,755) dengan nilai P 0,039. Analisa lebih lanjut dengan rasio odd, dimana pasien dengan peningkatan jumlah leukosit jaringan vena memiliki 4 kali lipat kemungkinan menderita insufisiensi vena kronik (Crude OR 4,81; CI 95% 1.02 - 22.57; P value 0.046), dan setelah dianalisa menggunakan variabel perancu usia, jenis kelamin, Diabetes mellitus, Hipertensi, Perokok, Dislipidemia, adjusted OR bertambah menjadi 6 kali lipat (Adjusted OR 6,66; CI 95% 1.16 - 38.31; P value 0.033)Kesimpulan. Terdapat hubungan antara nilai inflamasi lokal dengan parameter hitung jumlah lekosit jaringan vena dengan fungsi vena pada pasien insufisiensi vena kronik dengan parameter time refluks yang diperiksa dengan DUS.

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ABSTRACTBackground: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variablesResult: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients.;Background: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variablesResult: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients., Background: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variablesResult: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients.]"